Surgical Management of Caseous Calcification of the Mitral Annulus

Abstract

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification; it can manifest with conduction abnormalities or systemic embolization. It typically involves the posterior mitral annulus, and surgery is indicated for severe mitral valve dysfunction, for embolic complications or when the diagnosis is not certain. We describe a structured approach to the surgical management of CCMA using bovine pericardium to repair the defect.

Mitral Regurgitation Due to Caseous Calcification of the Mitral Annulus

“…There is no standard treatment for caseomas. A small amount of calcium deposition in the mitral valve annulus is often clinically insignificant and is managed conservatively while severe cases are treated with mitral valve replacement via sternotomy [ 8 ]. Prior to surgery, a Society of Surgery (STS) risk score is often calculated and serves as a determinant of eligibility for cardiac procedures.…”

Caseous mitral valve calcification and concurrent hypertrophic obstructive cardiomyopathy: A rare cause of stroke

“…Also, the risk of tPA associated hemorrhagic conversion of embolic stroke in these patients warrants more studies on a larger scale. Current studies focused on the imperativeness of conservative management in treating early CCMA by controlling other cardiovascular comorbidities (hypertension, dyslipidemia) and prevention of complications such as arrhythmias [10] , [11] . Antithrombotic therapy is reserved for patients with CVA and cardioembolic complications.…”

Caseous calcification of the mitral annulus: case report and brief review

“…No standard treatment protocol for CCMA exists, but surgery is generally indicated for severe mitral valve dysfunction related to other conditions and surgical management has been implemented in cases of CCMA with severe symptomatic mitral regurgitation, stenosis, or systemic embolization of caseous material, with considerable success 2 , 7 . While most patients are instead treated conservatively and spontaneous resolution or transformation back to typical MAC has been described, there are also cases where CCMA recurred even after surgical excision 2 , 12 , 13 …”

“…Although CCMA is generally a benign and asymptomatic condition, it is often misconstrued as a cardiac tumour (benign or malignant), abscess, or calcified vegetation based on imaging 5 , 6 . This condition can also manifest with conduction abnormalities or sometimes with systemic embolization of caseous material 7 . Caseous calcification of the mitral annulus is nearly always described as involving the posterior portion of the mitral annulus, but uncommonly involves the anterior portion alone or the entire annulus 8 …”