Caseous calcification of the mitral annulus; scary image during robotic surgery

J Card Surg. 2020 May;35(5):1145-1147. doi: 10.1111/jocs.14545. Epub 2020 Apr 15.

Abstract

Caseous calcification of the mitral annulus (CCMA) is a very rare form of mitral annular calcification (MAC). CCMA accounts for 0.63% of all cases and 0.06-0.07% of the total population and usually seen in elderly and female patients. It mostly affects the posterior leaflet of the mitral valve. The pathogenesis of CCMA remains unclear. Hypercholesterolemia and the dissolution of lipid-laden macrophages may be implicated in liquefaction necrosis. CCMA is composed of a mixture of calcium, fatty acid, and cholesterol. The name "caseous" comes from the cheese-like or toothpaste-like consistency of the mass. Cardiac magnetic resonance imaging may help in differentiating MAC from CCMA and should perform. The first treatment option should be conservative treatment because of surgical complications of the procedure. We presented a case report which is about CCMA with preoperative and intraoperative robotic images.

Keywords: cardiovascular pathology; valve repair/replacement.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Calcinosis / diagnostic imaging*
  • Calcinosis / pathology
  • Calcinosis / surgery*
  • Fatal Outcome
  • Female
  • Heart Valve Diseases / diagnostic imaging*
  • Heart Valve Diseases / pathology
  • Heart Valve Diseases / surgery*
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Intraoperative Period
  • Mitral Valve / diagnostic imaging*
  • Mitral Valve / pathology
  • Mitral Valve / surgery*
  • Multimodal Imaging*
  • Robotic Surgical Procedures / methods*