Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease. She was referred to our department for coronary catheterization because of angina symptoms upon minimal exertion. The lesion was detected during echocardiography and was defined as a mass of heterogeneous content with calcification points, located at the posterior side of the mitral valve annulus. Restricted motion of the posterior leaflet and the mass effect caused only minimal mitral regurgitation. To establish the correct diagnosis, we performed the full spectrum of noninvasive cardiac imaging modalities. Transesophageal echocardiography identified well-organized, composite lesion with regular edges, markedly calcified margins and more echolucent central portion. A computed tomography (CT) was performed, showing a hyperdense mass with hypodense center and a calcified peripheral rim located at the posterior mitral ring. Cardiac magnetic resonance imaging (MRI) showed that the mass was hypointense with respect to the myocardium in the T1 and T2-weighted sequences and only presented late-phase enhancement in the surrounding capsule. Based on the CT and MRI findings, the diagnosis of CCMA was established. The patient was managed conservatively.
Background:
Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) are
two noninvasive techniques for the evaluation of cardiac function for patients with coronary artery
diseases. Although echocardiography is the commonly used technique in clinical practice for the
assessment of cardiac function, the measurement of LV volumes and left ventricular ejection fraction (LVEF) by the use of this technique is still influenced by several factors inherent to the protocol acquisition, which may affect the accuracy of echocardiography in the measurement of global
LV parameters.
Objective:
The aim of this study is to compare the end systolic volume (ESV), the end diastolic
volume (EDV), and the LVEF values obtained with three dimensional echocardiography (3D echo)
with those obtained by CMRI (3 Tesla) in order to estimate the accuracy of 3D echo in the assessment of cardiac function.
Methods:
20 subjects, (9 controls, 6 with myocardial infarction, and 5 with myocarditis) with age
varying from 18 to 58, underwent 3D echo and CMRI. LV volumes and LVEF were computed
from CMRI using a stack of cine MRI images in a short axis view. The same parameters were calculated using the 3D echo. A linear regression analysis and Bland Altman diagrams were performed to evaluate the correlation and the degree of agreement between the measurements obtained
by the two methods.
Results:
The obtained results show a strong correlation between the 3D echo and CMR in the
measurement of functional parameters (r = 0.96 for LVEF values, r = 0.99 for ESV and r= 0.98 for
EDV, p < 0.01 for all) with a little lower values of LV volumes and higher values of LVEF by 3D
echo compared to CMRI. According to statistical analysis, there is a slight discrepancy between the
measurements obtained by the two methods.
Conclusion:
3D echo represents an accurate noninvasive tool for the assessment of cardiac function. However, other studies should be conducted on a larger population including some complicated diagnostic cases.
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