SHM Converge Scientific Abstract ePoster Gallery-Mobile Mitral Valve Calcifications: Not Your Usual Endocarditis

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This case report describes a 42-year-old woman with end-stage renal disease on hemodialysis who presented with worsening shortness of breath and was initially suspected of having infective endocarditis after transthoracic echocardiography (TTE) showed mobile lesions on the mitral and aortic valves. Her workup was not supportive of infection: she was afebrile, had negative blood cultures, normal white blood cell count, and negative Bartonella and Coxiella testing. Although inflammatory markers were elevated, the inpatient team pursued transesophageal echocardiography (TEE) because the pretest probability of endocarditis was not high.<br /><br />TEE clarified that the “mobile masses” were due to severe mitral annular calcification (MAC) with thickening of the mitral annulus and moderate mitral inflow obstruction, rather than vegetations. The patient was managed conservatively at first because the valve disease was not initially considered severe enough for surgery. Four months later, she returned with persistent dyspnea. Repeat evaluation showed no major echocardiographic change, but cardiac catheterization revealed severe mitral inflow tract obstruction, and she ultimately underwent mechanical mitral valve replacement.<br /><br />The report emphasizes that MAC is a chronic degenerative condition associated with older age, chronic kidney disease, diabetes, hypertension, dyslipidemia, and tobacco use. Importantly, patients on hemodialysis—despite being younger—have a high risk of MAC, and more than one-third may develop it after several years of dialysis. MAC can mimic endocarditis on TTE, creating a diagnostic pitfall. The authors highlight the importance of TEE for better characterization of valvular abnormalities when clinical suspicion for infection is low, especially in ESRD patients without classic signs of endocarditis.

Asset Subtitle

Robert S. Fain

Meta Tag

Author List Hussain R. Khawaja, Robert S. Fain, Sohum Patwa

Category Clinical Vignettes

Concept Mitral Annulus Calcification

Concept Transesophageal Echocardiography

Concept Valvular Deposit

Concept Mitral Valve Lesion

Concept Infective Endocarditis

Distinguished Non-Finalist

Presenter Organization Warren Alpert Medical School of Brown University

Presenting Author Robert S. Fain

Track Adult

Keywords

mitral annular calcification

end-stage renal disease

hemodialysis

transesophageal echocardiography

transthoracic echocardiography

infective endocarditis

mitral valve obstruction

valvular masses

cardiac catheterization

mechanical mitral valve replacement

Mitral Annulus Calcification

Transesophageal Echocardiography

Valvular Deposit

Mitral Valve Lesion

Infective Endocarditis