Korean Circ J.  2022 Jan;52(1):89-92. 10.4070/kcj.2021.0316.

A Case of Endocarditis on Mitral Annular Calcification

• Choi JH
• Park YH
• Lee SH
• Lee SY
• Je HG

• KMID: 2524175
• DOI: http://doi.org/10.4070/kcj.2021.0316

Abstract

no abstract available.

Figure

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  Figure 1 Chest X-ray showed cardiomegaly and calcification in the heart (yellow arrows).

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  Figure 2 Chest computed tomography demonstrated massive calcification of posterolateral aspect of mitral annulus (yellow arrow) and low density mass on the left atrial side of calcification (red arrow).

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  Figure 3 Transthoracic echocardiographic images. (A) Parasternal long axis view demonstrated MAC with vegetation. (B) Apical 4 chamber view demonstrated inhomogenous echogenic mass attached to MAC on left atrial side which was intermittently seen due to acoustic shadowing of MAC.MAC = mitral annular calcification.

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  Figure 4 Transesophageal echocardiography images. (A) Mid-esophageal 115° view demonstrated round vegetation on poster MAC. (B) In mid-esophageal 59° view, size of vegetation was 1.2×1.1 cm. (C) Color flow imaging revealed no significant steno-insufficiency of mitral valve. (D) Three-dimensional image showed large vegetation attached to posterior mitral annulus.LA = left atrium; LV = left ventricle; MAC = mitral annular calcification.

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  Figure 5 Operative findings (A) Vegetation (yellow arrow) was being resected by curved scissor. (B) Calcium on mitral annulus was being removed by curved scissor. (C) Defect on posterior mitral annulus after removal of vegetation and calcium was repaired by bovine pericardium (yellow arrow).

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  Figure 6 Postoperative transthoracic echocardiography showed no vegetation and fistula adjacent to remaining MAC (A, B).MAC = mitral annular calcification.

Reference

1. Eicher JC, De Nadai L, Soto FX, et al. Bacterial endocarditis complicating mitral annular calcification: a clinical and echocardiographic study. J Heart Valve Dis. 2004; 13:217–227. PMID: 15086260.

2. Pressman GS, Rodriguez-Ziccardi M, Gartman CH, et al. Mitral annular calcification as a possible nidus for endocarditis: a descriptive series with bacteriological differences noted. J Am Soc Echocardiogr. 2017; 30:572–578. PMID: 28366636.