SHM Converge Scientific Abstract ePoster Gallery-Attack of Mitral Annulus Calcifications

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The document describes caseous calcification of the mitral annulus (CCMA), a rare form of mitral annular calcification (MAC). MAC is commonly seen on cardiac imaging, especially in older patients and those with risk factors such as hypertension, hyperlipidemia, chronic kidney disease, smoking, obesity, and female sex. CCMA is less common, often occurs in younger patients than typical MAC, and is strongly associated with end-stage renal disease.<br /><br />The case involves a 39-year-old woman with hemodialysis-dependent end-stage renal disease, hypertension, and diabetes who presented with typical anginal symptoms. She had a murmur on exam, elevated troponins, and inferolateral ST-segment elevations, prompting STEMI activation. However, cardiac catheterization showed only non-obstructive coronary disease with a 20–30% proximal left circumflex lesion. Transthoracic echocardiography revealed a large mass near the posterior mitral leaflet, and transesophageal echocardiography further characterized it as severe CCMA with an associated mobile plaque.<br /><br />The report emphasizes that MAC/CCMA may be found incidentally on transthoracic echocardiography, but because the differential diagnosis includes tumor, endocarditis, and myxoma, transesophageal echocardiography is often needed for full evaluation. CCMA and MAC are associated with higher atherosclerotic burden, coronary artery disease, embolic stroke risk, and mitral regurgitation.<br /><br />In this case, the mobile plaque likely caused transient embolization leading to the STEMI-like presentation, with later resolution of the ECG changes. The patient was started on high-intensity statin therapy and indefinite dual antiplatelet therapy, and was referred to cardiothoracic surgery and cardiology for further management, including possible mass resection and valve repair.

Asset Subtitle

Besim Ademi

Meta Tag

Author List Besim Ademi, Luke Taggart

Category Clinical Vignettes

Concept Mitral Annulus Calcification

Concept Caseous Calcification of the Mitral Annulus

Concept Transesophageal Echocardiography

Concept Echocardiography

Concept Atherosclerotic Burden

Distinguished Non-Finalist

Presenter Organization Tulane University School of Medicine

Presenting Author Besim Ademi

Track Adult

Keywords

caseous calcification

mitral annulus

mitral annular calcification

end-stage renal disease

hemodialysis

transesophageal echocardiography

STEMI mimic

mobile plaque

mitral regurgitation

coronary artery disease

Mitral Annulus Calcification

Caseous Calcification of the Mitral Annulus

Transesophageal Echocardiography

Echocardiography

Atherosclerotic Burden