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Mitral Annulus Calcification is associated with valvular and cardiac structural abnormalities
Mohammad-Reza Movahed, Yuji Saito, Mastaneh Ahmadi-Kashani, Ramin Ebrahimi
Cardiovascular Ultrasound , 2007, DOI: 10.1186/1476-7120-5-14
Abstract: For this study we retrospectively reviewed 24,380 echocardiograms performed for clinical reasons between the years 1984 and 1998.MAC was reported in 1,494 (6.1%) subjects. Using multivariate analysis, age, left ventricular hypertrophy (LVH), mitral regurgitation (MR), tricuspid regurgitation (TR), aortic stenosis (AS), left atrial (LA) enlargement and reversed E/A ratio were independently associated with MAC.)MAC was noted in 11.7 % of patients with MR vs. 4.3% without MR (OR: 2.0, CI 1.6–2.6, p < 0.0001), in 13.9% of those with TR vs. 4.5% without TR (OR: 3.8, CI 2.9–4.8, p < 0.0001), in 10.6% with LVH vs. 4.2% without LVH (OR: 1.9, CI 1.5–2.4, p < 0.0001), in 14.8% with AS vs. 5.5% without AS (OR: 1.4, CI 1.08–1.9, p = 0.01), in 9.4% with reversed E/A ratio vs. 3.8% without reversed E/A ratio (OR: 1.7, CI 1.4–2.2, p < 0.0001) and in 8.2% with LA enlargement vs. 4.8% without LA enlargement (OR: 1.3, CI 1.06–1.7, p = 0.02).In our study, MAC independently correlated with significant structural heart abnormalities. This suggests that identification of MAC may serve as a marker for other cardiac structural disorders.Idiopathic (degenerative) mitral annular calcification (MAC) is one of the most common cardiac abnormalities found upon autopsy. Four examples of normal, mild, moderate and severe MAC can be seen in figure 1. Although the development of degenerative calcification of the mitral annulus is functionally of little consequence in most hearts, it shares common risk factors with atherosclerosis; including systemic hypertension, hypercholesterolemia, and diabetes [1]. Therefore it is important to risk-stratify patients with MAC because of its association with other important disorders such as coronary and carotid atherosclerosis and increased risk for cardiovascular morbidity and mortality [1-3].It has also been suggested that MAC might become an important cause of mitral regurgitation (MR) when calcification is severe [4,5]. Previous observational studies suggest
Caseous Calcification of the Mitral Annulus: A Rare Cause of Intracardiac Mass  [PDF]
Anxo Martinez-de-Alegria,Jose Rubio-Alvarez,Sandra Baleato-Gonzalez
Case Reports in Radiology , 2012, DOI: 10.1155/2012/596962
Abstract: Caseous calcification of the mitral annulus is a rare form of periannular calcification with a mass-like appearance, that has to be in the differential of the cardiologist and radiologist. It classically looks like a round or semilunar hyperdense mass with an even denser peripheral rim, located in the posterior mitral annulus and having in general no clinical significance. 1. Case Presentation A 76-year-old woman with atrial fibrillation and hyperlipidemia underwent a routine echocardiography. She presented a round cistic lesion with echodense rim in the mitral valve annulus (Figure 1), not associated to valvular dysfunction or related symptoms. A ECG-gated cardiac CT was performed (Figure 2) that showed a semilunar mass with hypodense center and a calcified peripheral rim, locally thickening the inferior and posterolateral basal left ventricular wall. The central content had homogeneous fluid density and no significant contrast enhancement. Figure 1: Echocardiographic apical four-chamber view showing a large oval echolucent mass with echodense rim in the mitral annular region. Figure 2: Cardiac CT, long axis (a) and short axis (b) views, showing a crescent-shaped hypodense mass with peripheral linear calcification that produces a shifting of posterior leaflet of mitral valve. No alterations of valvular function were found. After ruling out clinically abscessified mitral calcification, the imaging findings were considered highly suggestive of caseous calcification of the mitral annulus. Surgery was not needed due to the absence of coexistent mitral valve lesions and the patient was followed up conservatively, showing no echocardiographic changes after one year. 2. Discussion Caseous calcification of the mitral annulus, also called liquefaction necrosis, is a chronic degenerative process of the mitral valve fibrous ring, primarily involving the posterior annulus. It is a common disorder in the elderly, mainly in women, observed at autopsy in 8% of the population but rarely seen in imaging [1]. As an expression of atherosclerosis, it has identical risk factors as cardiovascular disease [2]. The precise mechanisms involved in the caseous calcification of mitral annulus are not known, but it is at present considered a dynamic entity. In different published reports of patients followup, some cases of caseous calcification disappeared spontaneously, replaced by simple annular calcification, whereas other patients with common annular calcifications developed central echolucent zones compatible with caseous calcification [3, 4]. The typical echocardiographic
Cardiovascular magnetic resonance features of caseous calcification of the mitral annulus
Lorenzo Monti, Eva Renifilo, Manuel Profili, Luca Balzarini
Journal of Cardiovascular Magnetic Resonance , 2008, DOI: 10.1186/1532-429x-10-25
Abstract: Cardiovascular Magnetic Resonance (CMR) is unrivalled as an imaging modality for the evaluation of cardiac and pericardial masses. Caseous calcification of the mitral annulus is a rare [1-4] form of degeneration of the fibrous skeleton of the mitral annulus that should be included in the differential diagnosis of myocardial masses. Usually found in elderly patients, it's typically located in the posterior mitral annulus. We studied with CMR two cases of caseous calcification of the mitral annulus; in both cases the diagnosis was confirmed with a CT scan.Patient 1. A 87-year-old woman was referred to our Hospital with suspicion of an atrial mass. A CMR study (Figure 1) showed appearances compatible with extensive caseous calcification of the posterior mitral annulus, with dimensions of 3 × 2.5 cm and a circumferential extension of about 5 cm, in the basal inferior wall of the left ventricle and bulging into the posterior left atrium, without significant mitral valve regurgitation.Patient 2. A 70-year-old male, who had undergone bone marrow transplantation for a follicular non-Hodgkin's lymphoma, was referred after transthoracic echocardiography had identified a hyperechogenic intramyocardial mass in the postero-lateral basal wall. CMR (Figure 2) and CT scan (Figure 3) confirmed the diagnosis of caseous calcification of the mitral annulus.Both patients were asymptomatic at the time of diagnosis and were treated conservatively.The CMR findings of the two patients are similar. In T1-weighted (T1W) sequences (Panel A in Fig. 1 and 2) the masses are dark, and in fat suppressed T2-weighted (T2W) STIR sequences (Panel B in Fig. 1 and 2) they lack signal. The combination of dark T1W and T2W tissue signal is unusual for a cardiac mass [5] and suggests calcification. In balanced steady state free precession (bSSFP) images the regions of caseous calcification (* in Panel C in Fig. 1 and 2) appear only slightly darker than the normal myocardium, with a well-defined intramyocardi
Caseous calcification of the mitral annulus with mitral regurgitation and impairment of functional capacity: a case report
Giovanni Minardi, Carla Manzara, Giovanni Pulignano, Paolo G Pino, Herribert Pavaci, Martina Sordi, Francesco Musumeci
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-205
Abstract: We report the case of a 69-year-old woman, in whom caseous calcification of the mitral annulus was found at transthoracic echocardiography. Cardiac surgery was performed because of significant mitral regurgitation and impairment of functional capacity.Caseous calcification of the mitral annulus needs to be considered and confirmed by transthoracic echocardiography since there is potential for diagnostic confusion or misdiagnosis. This lesion appears to have a benign prognosis but, when associated with mitral valve dysfunction, cardiac surgery appears to be the best therapeutic option.Mitral annular calcification (MAC) is a chronic degenerative process, which occurs mainly in older patients, particularly in women and in patients with end-stage renal failure on chronic dialysis [1]. Caseous calcification of the mitral annulus (CCMA) is a relatively rare variant with an echocardiographic prevalence of 0.6% in patients with MAC and 0.06% to 0.07% in large series of patients of all ages [2,3].We describe a patient who was referred to our echocardiographic laboratory because of progressive impairment of functional capacity (up to New York Heart Association (NYHA) class III), and in whom moderate to severe mitral regurgitation (MR) and CCMA were found.A symptomatic 69-year-old woman (NYHA functional class III) underwent a transthoracic echocardiographic (TTE) examination to assess her left ventricular function. Her past history included hypercholesterolaemia, hypothyroidism and paroxystic atrial fibrillation. A DDD type pacemaker had been implanted due to sick sinus syndrome one year previously. She had marked limitation of physical activity. She was comfortable at rest but breathless on mild exertion. Physical examination revealed a pansystolic murmur of grade 3/6 audible in the mitral area. An electrocardiogram was completely normal. Laboratory examinations were as follows: haemoglobin 12.3 g/dl, glycaemia 72 mg/dl, urea 37 mg/dl, creatinine 0.9 mg/dl, calcium 8.7 mmol/l
Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness
Luca Sgorbini, Angelo Scuteri, Massimo Leggio, Francesco Leggio
Cardiovascular Ultrasound , 2004, DOI: 10.1186/1476-7120-2-19
Abstract: To examine the relationship between the degree of calcification at mitral and/or aortic valve annulus and large artery structure (thickness).We evaluated 102 consecutive patients who underwent transthoracic echocardiography and carotid artery echoDoppler for various indications; variables measured were: systemic blood pressure (BP), pulse pressure (PP=SBP-DBP), body mass index (BMI), fasting glucose, total, HDL, LDL chlolesterol, triglycerides, cIMT. The patients were divided according to a grading of valvular/annular lesions independent scores based on acoustic densitometry: 1 = annular/valvular sclerosis/calcification absence; 2 = annular/valvular sclerosis; 3 = annular calcification; 4 = annular-valvular calcification; 5 = valvular calcification with no recognition of the leaflets.Patient score was the highest observed for either valvular/annulus. Mean cIMT increased linearly with increasing valvular calcification score, ranging from 3.9 ± 0.48 mm in controls to 12.9 ± 1.8 mm in those subjects scored 5 (p < 0.0001). In the first to fourth quartile of cIMT values the respective maximal percentual of score were: score 1: 76.1%, score 2: 70.1%, score 4: 54.3% and score 5: 69.5% (p > 0.0001).MAC and AVC score can identify subgroups of patients with different cIMT values which indicate different incidence and prevalence of systemic artery diseases. This data may confirm MAC-AVC as a useful important diagnostic parameter of systemic atherosclerotic disease.Mitral annular calcification (MAC) and aortic annular calcification (AVC) are observed in populations that develop significant atherosclerosis and more frequently in the elderly [1]. Previous pathological studies have suggested they represent a degenerative process that progresses with advancing age [2-4]. Consistently with this hypothesis, several ultrasound cardiovascular studies demonstrated a significant association between MAC and coronary artery disease, aortic atheroma and peripheral arterial atherosclerotic d
Multi Modality Imaging for Cardiac Masses Can Avoid Unnecessary Surgical Intervention: A Case Report of Caseous Calcification of Mitral Annulus  [PDF]
Karam Alzuhairi, Tomas Zaremba, Eva Korup
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.41009
Abstract: Mitral Annular Calcification (MAC) is a degenerative process involving the fibrous ring of the mitral valve. Caseous Calcification of Mitral Annulus (CCMA) is a rare variant of MAC. This condition is benign and usually needs no treatment. This is a case report of a 67-year-old woman with non-specific symptoms in whom a cardiac tumor was suspected by transthoracic Echocardiography. The use of multi-modality imaging strategy with transesophageal Echocardiography and cardiac MR scanning revealed however the diagnosis of CCMA and spared the patient an unnecessary operation.
Severe mitral annular calcification in rheumatic heart disease: A rare presentation  [cached]
Rajesh Vijayvergiya,Kim Vaiphei,Sandeep S Rana
World Journal of Cardiology , 2012, DOI: 10.4330/wjc.v4.i3.87
Abstract: Severe mitral annular calcification (MAC) is frequently seen in patients with advanced age and chronic kidney disease, but it is rare in rheumatic heart disease (RHD). We hereby report a case of 45-year-old female with chronic RHD, who had severe MAC and mitral regurgitation. Fluoroscopy revealed a “crown”-like severe calcification of the mitral annulus. Autopsy of the heart revealed a calcified posterior mitral annulus, fused commissures, and calcified nodules at the atrial aspect of the mitral valve.
Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography  [cached]
Toufan M,Javadrashid R,Paak N,Gojazadeh M
International Journal of General Medicine , 2012,
Abstract: Mehrnoush Toufan,1 Reza Javadrashid,2 Neda Paak,2 Morteza Gojazadeh,3 Majid Khalili41Cardiovascular Research Center, 2Department of Radiology, 3Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 4Azerbaijan National Academy of Sciences, Baku, AzerbaijanBackground: Mitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography.Methods: Of 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings.Results: Mitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001).Conclusion: Mitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography.Keywords: mitral annular calcification, mitral valve leaflet calcification, multidetector computed tomography, mitral regurgitation, mitral stenosis
Intracardiac Calcification - An Interesting Chest X-ray Report.  [cached]
Vishnu Sharma M,Anupama N,Narayana Pradeepa,Harsha DS
Online Journal of Health & Allied Sciences , 2013,
Abstract: We report a case of chest X-ray finding of mitral annular calcification. Mitral annular calcification is a degenerative process involving the fibrous annulus of the mitral valve. It is generally an incidental finding associated with aging and atherosclerosis. It may lead to significant mitral regurgitation and can rarely cause symptomatic mitral stenosis. In addition, mitral annulus calcification may be associated with atrial fibrillation and cardiac arrhythmia. Calcification of mitral annulus in the chest X-ray generally follows the C-shape of the mitral annulus. Confirmation is by echocardiography. Symptomatic cases require repair by surgery.
Relationship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography
Toufan M, Javadrashid R, Paak N, Gojazadeh M, Khalili M
International Journal of General Medicine , 2012, DOI: http://dx.doi.org/10.2147/IJGM.S33665
Abstract: tionship between incidentally detected calcification of the mitral valve on 64-row multidetector computed tomography and mitral valve disease on echocardiography Original Research (808) Total Article Views Authors: Toufan M, Javadrashid R, Paak N, Gojazadeh M, Khalili M Published Date October 2012 Volume 2012:5 Pages 839 - 843 DOI: http://dx.doi.org/10.2147/IJGM.S33665 Received: 14 May 2012 Accepted: 21 August 2012 Published: 10 October 2012 Mehrnoush Toufan,1 Reza Javadrashid,2 Neda Paak,2 Morteza Gojazadeh,3 Majid Khalili4 1Cardiovascular Research Center, 2Department of Radiology, 3Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 4Azerbaijan National Academy of Sciences, Baku, Azerbaijan Background: Mitral valve calcification is often incidentally detected on chest computed tomography (CT) scans obtained for a variety of noncardiac indications. In this study, we evaluated the association between mitral valve calcification incidentally detected on chest CT and the presence and severity of mitral valve disease on echocardiography. Methods: Of 760 patients undergoing 64-row multidetector CT of the chest, 50 with mitral valve calcification and 100 controls were referred on for echocardiography. Calcifications of the mitral valve leaflet and annulus were assessed for length, Agatston score, and site, and were compared with echocardiographic findings. Results: Mitral valve calcification was noted in 59 (7.7%) patients on multidetector CT. Fifty of these patients were assessed by echocardiography, and 32 (64%) were found to have mitral annular calcification. Nine patients (18%) had posterior mitral valve leaflet calcification, and both mitral valve leaflet and annular calcification were detected in nine (18%) cases. Nine (18%) patients had mild, three (6%) had moderate, and one (2%) had severe mitral stenosis. None of the patients with isolated mitral annular calcification had mitral stenosis; however, all the patients with mitral stenosis showed mitral valve leaflet calcification with or without mitral annular calcification (P < 0.001). Moreover, patients with mitral stenosis had a larger mitral calcification length and greater Agatston scores in comparison with those without mitral stenosis (P = 0.001). While 31 patients (62%) with mitral calcification had mitral regurgitation on echocardiography, 21 (21%) in the control group showed mitral regurgitation (P = 0.001). Conclusion: Mitral valve leaflet calcification, with or without annular calcification, may be an indicator of mitral stenosis. Mitral calcification can also be considered as an indicator for mitral regurgitation in general. Therefore, patients with mitral valve calcification detected incidentally on chest CT scan may benefit from functional assessment of the valve using echocardiography.
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