Caseous calcification of the mitral annulus associated with stroke: Report of two cases

Sagnier, Sharmila; Poli, Mathilde; Oysel-Mestre, M.; Corneloup, O.; Debruxelles, Sabrina; Renou, Pauline; Rouanet, François; Sibon, Igor

doi:10.1016/j.neurol.2014.07.019

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…However, the rare subset of caseous mitral annular calcification has largely been documented as benign 5 6. More recently, some case reports have reported caseous mitral annular calcification as an independent risk factor for patients’ cardioembolic strokes 7–9. On our review of the literature, no studies or case reports have described CCPM, let alone identified it as a source of cardioembolism to the brain.…”

Section: Discussionmentioning

confidence: 86%

“…5 6 More recently, some case reports have reported caseous mitral annular calcification as an independent risk factor for patients' cardioembolic strokes. [7][8][9] On our review of the literature, no studies or case reports have described CCPM, let alone identified it as a source of cardioembolism to the brain. We suspected CCPM as the aetiology of our patient's strokes for multiple reasons.…”

Section: Discussionmentioning

confidence: 97%

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Cardioembolic stroke in the setting of diffuse caseous calcification of the anterolateral papillary muscle

Gaini,

2023

BMJ Case Rep

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A woman in her 70s was admitted for acute, painless vision loss in the left eye. Examination showed cherry red spot in the macula and plaque in the nasal vessels, consistent with central retinal artery occlusion. MRI orbits revealed multifocal subclinical acute infarcts in the right middle cerebral artery (MCA) territory and bilateral cerebella. Transthoracic echocardiogram showed calcification of the anterolateral papillary muscle. Further characterisation with cardiac MRI elucidated caseous ‘toothpaste-like’ calcification of the muscle complex. Stroke workup was otherwise unremarkable. The patient underwent hyperbaric treatment with mild improvement. Anticoagulation and surgical intervention were deferred due to known risks and unknown benefit for calcific emboli. The patient was continued on her home dual anti-platelet therapy (DAPT) and discharged with a loop monitor. Caseous calcification of the papillary muscle (CCPM) may be a risk factor for cardioembolic stroke. Further discussions on medical and surgical guidelines for CCPM would be beneficial for stroke prevention.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 97%

Cardioembolic stroke in the setting of diffuse caseous calcification of the anterolateral papillary muscle

Gaini,

2023

BMJ Case Rep

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“…In Framingham Heart Study, for every 1-mm increase in mitral annular calcification, the risk of incident CVD, death, and all-cause mortality increased by 9% (p < 0.007), 12% (p < 0.004) and 9% (p < 0.001) [6]. Sagnier S, et al described a patient with CCMA associated with stroke [7].…”

Section: Discussionmentioning

confidence: 99%

Caseous Calcification of the Mitral Annulus: From Asymptomatic Lesion to Embolic Complication- Case Report

Mitrovska¹,

Jovev²,

Vasil³

et al. 2022

Int J Clin Cardiol

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“…Calcification of the mitral annulus has been associated with the risk of stroke (especially CCMA), infective endocarditis, and atrial fibrillation. Increasing the thickness of the lesions by 1 mm resulted in a 10% increase in the risk of stroke [12,13]. In almost 20% of patients operated on, for this reason, bacterial endocarditis was demonstrated [14].…”

Section: Discussionmentioning

confidence: 99%

The Importance of Cardiac Computed Tomography in the Diagnosis of Caseous Calcification of the Mitral Annulus—Case Reports

Gać

Cheładze²,

Poręba

2022

Diagnostics

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Mitral annular calcification (MAC) is a common pathology of the mitral valve. In rare cases, calcifications occur in the mitral annulus degenerate serous; the caseous calcification of the mitral annulus (CCMA) then develops. Detection of CCMA is often random and requires differentiation from heart tumors or an abscess. The paper presents two cases of patients with ambiguous focal lesions of the mitral valve in echocardiography. In the first case, the cardiac computed tomography (CCT) showed a spherical, slightly irregular structure measuring approximately 33 × 22 mm, which was in contact with the posterior mitral valve leaflet from the lumen of the left ventricle. The lesion was heterogeneously intense, with an average density of about 500 HU and up to 975 HU on the periphery; it was not enhanced after the administration of a contrast agent. In the second case, the CCT revealed a heterogeneous, highly calcified structure in the peripheral zone and intermediate density in the central zone in the topography of the posterior mitral valve leaf, with dimensions up to about 41 × 31 mm in the plane of the valve leaflet, passing into the lumen of the left ventricle along its inferolateral wall to a depth of about 3.5 cm. In both cases, CCT enabled the diagnosis of CCMA. In conclusion, cardiac computed tomography may be decisive in the case of suspected caseous calcification of the mitral annulus where there is ambiguous echocardiography.

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Caseous calcification of the mitral annulus associated with stroke: Report of two cases

Cited by 4 publications

References 24 publications

Cardioembolic stroke in the setting of diffuse caseous calcification of the anterolateral papillary muscle

Cardioembolic stroke in the setting of diffuse caseous calcification of the anterolateral papillary muscle

Caseous Calcification of the Mitral Annulus: From Asymptomatic Lesion to Embolic Complication- Case Report

The Importance of Cardiac Computed Tomography in the Diagnosis of Caseous Calcification of the Mitral Annulus—Case Reports

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