Mitral valve disease as well as uncommon extensive epipericardial and intramyocardial calcification secondary to massive mitral annular calcification

Abstract

A 71-year-old woman with a history of childhood pulmonary tuberculosis was admitted to our hospital for exertional dyspnoea (NYHA functional class II). Transthoracic and transoesophageal echocardiography demonstrated moderate to severe mixed mitral valve disease due to massive mitral annular calcification (MAC) and extensive infiltrative calcification of the atrioventricular groove. In addition, a very uncommon intramyocardial calcification of the ventricular septum and the lateral free wall was diagnosed. This case demonstrates a rare combination of mitral valve disease secondary to MAC, and a small hypertrophied left ventricle, as well as epipericardial and myocardial calcification likely due either to the massive MAC with myocardial extension or to former tuberculous perimyocarditis. The multidimensional imaging approach, which has been used in this particularly case, provided an excellent visualization and clinical evaluation of this rare finding.

Caseous Intracardiac Calcification: A Diagnostic Enigma

“…Intramyocardial and pericarditic causes of MAC can be unified through the diagnosis of tuberculosis. Whilst focal myocardial inflammation associated with previous active tuberculosis can become a precursor for calcific change [5], rarer causes of pericarditis-related calcification progressing to the myocardium are attributed to irradiation, ventricular aneurysms, systemic lupus erythematosus (SLE), and viral aetiologies. These patients typically present with pericardial constriction or from incidental imaging findings [6, 7].…”

Two cases of massive mitral annular calcification mimicking left atrial neoplasms

“…We observed interference with both the mitral valve and the left ventricular outflow tract by direct physical obstruction to blood flow. In some reports, the calcification has been described as extending into the myocardium10 with resultant dysfunction of the subvalavular apparatus and a restrictive cardiomyopathy 11. Both mitral regurgitation and mitral stenosis are described as consequences of this process 12…”