Calcified amorphous tumor of the heart in a hemodialysis patient

Surgical management for caseous calcification of mitral annulus associated with coronary artery disease

Mitral annular calcification (MAC) is a common finding, especially among the elderly or patients undergoing haemodialysis. Caseous calcification of the mitral annulus (CCMA) is a rare MAC variant with liquefied material at the calcified annulus. Surgical management of CCMA often involves wide excision and debridement, increasing the risk of perioperative stroke. We report a patient undergoing haemodialysis who developed an enlarged MAC, moderate mitral insufficiency and multivessel coronary artery disease. This case highlights the characteristic imaging features of CCMA. We performed a limited incision for complete drainage, followed by suture obliteration of the cavity and mitral valve repair, in conjunction with coronary artery bypass grafting. This technique was safe, preserved mitral valve function and was not associated with perioperative stroke. We herein report this approach reduces the risk of stroke while maintaining mitral valve function, offering a safer alternative to extensive excision.

Multiple cardiac calcified amorphous tumors with morphologically different characteristics complicated by aortic regurgitation: a case report

BACKGROUND

Cardiac calcified amorphous tumors (CATs) are non-neoplastic cardiac tumors of unknown origin and etiology. Several simultaneous CATs rarely occur in multiple cardiac chambers. Although CATs carry a benign prognosis, they have a risk of complications such as systemic embolism.

CASE PRESENTATION

We report the case of a 79-year-old woman with two CATs and aortic regurgitation due to perforations of aortic cusps. She underwent surgical tumor resection with aortic valve replacement. The CATs were macroscopically and histologically different, which may suggest different developmental stages. One CAT was in the left atrium; it was less mobile and had nodular calcifications within dense fibrous tissue. The other CAT was in the left ventricular outflow tract; it was highly mobile, with nodular calcifications surrounded by amorphous fibrin and sanguineous deposits. The highly mobile CAT mechanically damaged the aortic cusps and caused perforations. The patient has survived over 2 years with no recurrence of the cardiac masses on echocardiography.

CONCLUSION

The patient underwent surgical resection for two CATs. The tumors occurred in different areas and had different macroscopic and histological characteristics. We recommend early resection for highly mobile CATs because of the high risks of embolization and injuries to the surrounding tissues.

Case report: A primary calcified cardiac mass in right atrium partially obstructs the tricuspid valve in a patient on hemodialysis

Primary cardiac calcification is a rare benign mass in patients with end-stage renal disease. A few cases have been reported in the literatures. In this case study, during a routine checkup for hemodialysis, a transthoracic echocardiography on a 19-year-old male showed a cardiac mass in the right atrium that was partially obstructing the tricuspid valve. Cardiac magnetic resonance imaging showed a well-circumscribed, homogeneous "shadow" in the right atrium; it measured 29 × 27 mm, had equal T1- and T2-weighted signal intensities, and was adjacent to the tricuspid valve. According to 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography, there was a dense circular shadow in the right atrium abutting the tricuspid valve, but there was no increase in glucose metabolism. Median sternotomy was performed for the surgical resection of the mass, and a cardiopulmonary bypass was completed. The mass was completely removed. The patient recovered well and was discharged 10 days after the surgery. Histological examination showed that the mass contained multiple calcified nodules. No mass recurrence was found by echocardiography during the 12th-month follow-up.

The First Report of Calcified Amorphous Tumor Associated with Infective Endocarditis: A Case Report and Review of Literature

BACKGROUND Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, which is composed of calcium deposition surrounded by amorphous fibrous tissue. The clinical presentation of cardiac CAT resembles that of other cardiac tumors or vegetation, though there is no previous report of a CAT complicated with infective endocarditis. CASE REPORT A 67-year-old male with a history of end stage renal failure and gastric cancer who was on adjuvant chemotherapy presented with a cardiac mass. The mass was resected and diagnosed as CAT pathologically. Two separate sets of blood cultures were positive for Enterococcus faecalis, thus, the patient was diagnosed with infective endocarditis. Antibiotic treatment was continued for 6 weeks after surgery, and the patient recovered uneventfully. However, he died from a complication of his gastric cancer 5 months later. CONCLUSIONS This is the first report of CAT associated with infective endocarditis. Blood cultures should be obtained to differentiate infective endocarditis or CAT with infectious endocarditis from CAT alone, because CAT with infective endocarditis may present atypically and may be more likely to require antibiotic treatment along with surgery.

Calcified amorphous tumor with caseous calcification of mitral annulus in hemodialysis patients

Mitral annular calcification (MAC) is a common finding, especially among the elderly. Caseous calcification of the mitral annulus (CCMA) is a rare variant of MAC. Calcified amorphous tumor (CAT) is an extremely rare non-neoplastic cardiac tumor accompanied by calcification and is often associated with MAC. We encountered two patients with end-stage renal failure in whom a cardiac CAT developed on the mitral annulus. In both patients, preoperative examination showed MAC of the posterior mitral annulus and a mobile mass attached to the MAC. CAT and CCMA were considered, and surgical resection was performed because of a high risk of systemic embolization. Intraoperatively, the mobile mass was associated with the CCMA. The CCMA with the mass was entirely removed, and the diagnosis of CAT was histologically confirmed. We herein report these two cases of CAT arising from CCMA in patients undergoing hemodialysis and propose the characteristic imaging features and operative findings.

Echocardiographic assessment of cardiac structure and function in chronic renal disease

Chronic kidney disease (CKD) is a global health problem and is independently associated with increased risk for cardiovascular disease (CVD). The presence and severity of CKD is strongly related to the progression of coronary atherosclerosis, ventricular hypertrophy, myocardial fibrosis, valvular calcification, and cardiac conduction system abnormalities. Echocardiography plays a major role in the assessment of structural and functional cardiac abnormalities in CKD including abnormal left-ventricular (LV) geometry, LV diastolic dysfunction, valvular disease, and left atrial dilatation, which are very frequently present especially in patients with end-stage renal disease.

A Case of Cardiac Calcified Amorphous Tumor Presenting with Concomitant ST-Elevation Myocardial Infarction and Occipital Stroke and a Brief Review of the Literature

Cardiac calcified amorphous tumor (CAT) is an extremely rare benign intracavitary tumor of the heart. It may mimic other cardiac tumors and can present with signs or symptoms of systemic embolization. There are limited data regarding CAT in the literature. We report a case of a 68-year-old woman with a cardiac CAT and mitral annular calcification (MAC), who presented with acute ST-elevation myocardial infarction (STEMI) and occipital stroke. After extensive review of the literature, we believe that this case is possibly the first description of a cardiac CAT presenting with STEMI. The CAT was surgically removed, and the diagnosis was confirmed by histology. The patient tolerated the surgery and reported no events at 6-month follow-up.