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Serial Assessment of Liquefaction Necrosis of Mitral Annular Calcification by Echocardiography and Multislice Computed Tomography

2007; Lippincott Williams & Wilkins; Volume: 115; Issue: 1 Linguagem: Inglês

10.1161/circulationaha.106.635599

1524-4539

Naoyuki Yokoyama, Kumiko Konno, Shigeru Suzuki, Takaaki Isshiki,

Cardiac Valve Diseases and Treatments

HomeCirculationVol. 115, No. 1Serial Assessment of Liquefaction Necrosis of Mitral Annular Calcification by Echocardiography and Multislice Computed Tomography Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessReview ArticlePDF/EPUBSerial Assessment of Liquefaction Necrosis of Mitral Annular Calcification by Echocardiography and Multislice Computed Tomography Naoyuki Yokoyama, MD Kumiko Konno, MD Shigeru Suzuki, and MD Takaaki IsshikiMD Naoyuki YokoyamaNaoyuki Yokoyama From the Departments of Medicine (Cardiology) (N.Y., K.K., T.I.) and Radiology (S.S.), Teikyo University School of Medicine, Tokyo, Japan. , Kumiko KonnoKumiko Konno From the Departments of Medicine (Cardiology) (N.Y., K.K., T.I.) and Radiology (S.S.), Teikyo University School of Medicine, Tokyo, Japan. , Shigeru SuzukiShigeru Suzuki From the Departments of Medicine (Cardiology) (N.Y., K.K., T.I.) and Radiology (S.S.), Teikyo University School of Medicine, Tokyo, Japan. and Takaaki IsshikiTakaaki Isshiki From the Departments of Medicine (Cardiology) (N.Y., K.K., T.I.) and Radiology (S.S.), Teikyo University School of Medicine, Tokyo, Japan. Originally published2 Jan 2007https://doi.org/10.1161/CIRCULATIONAHA.106.635599Circulation. 2007;115:e1–e2An asymptomatic 54-year-old man, who had been on hemodialysis for 11 years because of chronic renal failure caused by chronic glomerulonephritis, was observed in our hospital. In November 2002, an aortic valve replacement was performed because of severe aortic stenosis. Preoperative echocardiography demonstrated mitral annular calcification (MAC) at the base of the posterior mitral annulus (Figure, A). Computed tomography of the heart also identified the MAC (Figure, B). In November 2004, follow-up echocardiography revealed enlargement of the MAC, which was detected as a spherical dense echogenic calcified mass (36×21 mm) with a central echolucent area (Figure, C). Trivial mitral regurgitation was observed. Electrocardiographic gated cardiac multislice computed tomography confirmed that the mass had a high density but also contained a low-density area that was thought to be soft tissue (Figure, D). Multislice computed tomography coronary angiography showed that the mass had no feeding artery. These findings suggested that this mass was a liquefaction necrosis of the MAC. Additional treatment was not performed because liquefaction necrosis of MAC usually has a benign prognosis. After 11 months, echocardiography and multislice computed tomography revealed that the size of the mass was reduced (16×6 mm), especially in the central liquefaction region (Figure, E and F). Doppler echocardiography also revealed moderate mitral regurgitation attributable to incomplete cooptation. Although the pathogenesis of MAC in chronic renal failure is related to calcium–phosphorus homeostasis, the levels of total serum calcium, serum phosphorus, and calcium–phosphorus product were not changed significantly during the observation period. These findings clearly demonstrated that liquefaction necrosis was a reversible form of MAC. Because mitral regurgitation with various grades could have been caused by the varying size of the MAC, further follow-up study was necessary for this case. Serial assessment was important in this particular disease. Download figureDownload PowerPointTwo-dimensional echocardiography of the parasternal long-axis view and multislice computed tomography demonstrating mitral annular calcification (A and B). After 2 years, the parasternal long-axis view revealed a large echo-dense mass at the base of the posterior mitral leaflet (C). The mass had a central echolucent area. A high-density mass with a low-density area within it was seen on multislice computed tomography at the base of the posterior mitral leaflet (D). Echocardiography (E) and computed tomography (F) performed 11 months later showed that the size of the mass and lucent area within the mass had decreased. The abnormal calcified mass is identified on the echocardiogram with an arrow head (A, C, and E) and on multislice computed tomography with an arrow (B, D, and F).DisclosuresNone.FootnotesCorrespondence to Naoyuki Yokoyama, MD, Department of Medicine (Cardiology), Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetails January 2, 2007Vol 115, Issue 1Article InformationMetrics Download: 121 https://doi.org/10.1161/CIRCULATIONAHA.106.635599PMID: 17200446 Originally publishedJanuary 2, 2007 PDF download SubjectsComputerized Tomography (CT)Echocardiography