Mobile intracardiac calcinosis: a new risk of thromboembolism in patients with haemodialysed end stage renal disease

Study on the Effect of Low Calcium Dialysate on Biochemical Profile of Adynamic Bone Disease in Patients on Maintenance Hemodialysis

In recent years, adynamic bone disease (ABD) has become a common skeletal lesion in adult patients with chronic kidney disease. We aimed to compare the effects of low calcium dialysate (LCD) and standard calcium dialysate of our facility [high calcium dialysate (HCD)] on the evolution of bone and mineral parameter related to ABD in dialysis patients. Forty patients with predialysis intact parathyroid hormone (iPTH) <100 pg/mL and/or bone-specific alkaline phosphatase (BAP) <27 U/L were included in this study and were equally distributed over LCD (1.25 mmol/L) or HCD (1.75 mmol/L) treatment. The duration of the study was 6 months. There was no significant difference in baseline characters and biochemical parameters related to chronic kidney disease-mineral and bone disorder in both the groups. The groups did not differ in the mean tCa before dialysis, but this parameter was significantly lower in the LCD group versus HCD at the end of the study. The mean serum levels of iPTH, total alkaline phosphatase, and BAP in the LCD group were increased at 3 months and at the end of the study compared with the baseline levels. The bone markers in the HCD group did not change significantly. At the end of the study, all bone parameters in the LCD group were significantly higher than in the HCD group. Development of measures indicating increased bone turnover in patients receiving 1.25 mmol/L of dialysate calcium, most likely as a result of inhibiting a positive calcium balance and allowing for long-term PTH secretion stimulation. Hence, LCD might be considered a valuable therapeutic option for ABD patients.

Cardiac Calcified Amorphous Tumor in the Neonatal Period

Calcified amorphous tumor (CAT) of the heart is a rare nonneoplastic cardiac mass that may exhibit symptoms resembling malignancy. In this report, we presented a 4-month-old male baby with repeated attacks of cyanosis and a cardiac murmur. Echocardiography revealed a tumoral noncircumscribed mass in the right atrium adhering to the interatrial septum which extends to the inferior vena cava. Cardiac exploration was carried out to excise the tumor. A histopathological study demonstrated the presence of thrombus-like tissue with extensive calcification and foreign body type giant cell reactions. After operation, the patient had an uneventful hospitalization. Although CAT is mainly diagnosed in adult patients, it should be considered in the causes of cardiac mass in the neonatal period.

Cerebral Embolism Associated with Calcified Amorphous Tumor: A Review of Cerebral Infarction Cases

Calcified amorphous tumor (CAT) is a non-neoplastic tumor composed of calcified nodules consisting of amorphous fibrous material, and it may eventually cause cerebral infarction (CI). We experienced a 67-year-old woman with CAT who had recurrent CI. After excision of the CAT, the CI did not show recurrence. A review of previous papers on CI due to CAT in Pubmed revealed that 7 of 13 studies originated in Japan and that CI can occur even with small CAT. Surgical treatment is recommended to prevent CI recurrence, especially when CAT is accompanied by mitral annular calcification or has marked mobility.

The “MAC” Attack: When Mitral Annular Calcification Goes Rogue! A Case Series of Mobile Mitral Annular Calcifications

•

CAT is a rare non-neoplastic tumor which may be associated with mobile MAC.

•

Mobile component carries a high risk of embolization demonstrated in our case series.

•

Calcified thrombus and CAT may be on a spectrum ranging from acute to chronic.

Cardiac calcified amorphous tumour associated with multiple myeloma

We report an 86-year-old woman who was diagnosed with multiple myeloma (MM) and was receiving chemotherapy since the age of 82. A high echoic mass attached to the mitral valve was observed on transthoracic echocardiography 4 years after the treatment. The possibility of malignancy could not be ruled out, and hence, the mass was excised surgically. Pathologically, most of the mass consisted of calcified lesion without tumour tissue, and these findings were not inconsistent with calcified amorphous tumour (CAT). This case suggests that CAT may be associated with MM and has been reported after a thorough literature review.

A Calcified Amorphous Tumor Originating in the Aortic Valve Cusp

Calcified amorphous tumor (CAT) of the heart is a rare nonneoplastic cardiac tumor. The clinical features of cardiac CATs resemble those of other cardiac tumors that include symptoms related to obstruction or embolization. Cardiac CATs have been found in all chambers of the heart but predominantly present in the left ventricle, mitral annulus, and mitral valve. Here we report an extremely rare case of CAT originating in the aortic valve cusp, which may be related to aortic annular calcification and aortic valve stenosis. We successfully treated this patient with tumor resection and aortic valve replacement.

Mobile thrombus originating from densely calcified mitral annulus with cerebral embolism

Mitral annular calcification (MAC) has been considered a predisposition and an association of thrombo-embolic disease. Superimposed thrombus on MAC is under-appreciated as a potential cause of systemic thrombo-embolism. This report describes an elderly gentleman, who had recurrent cerebral embolism and in one of the episodes, a large mobile thrombus was detected on the ventricular surface of calcified mitral annulus. The thrombus disappeared after initiation of anti-coagulation.

Swinging Calcified Amorphous Tumors With Related Mitral Annular Calcification

Among cardiac calcified amorphous tumors, the mitral annular calcification-related calcified amorphous tumor is extremely rare. We herein describe 3 surgical cases of swinging calcified amorphous tumor with related mitral annular calcification. The clinical, echocardiographic, and pathophysiologic features are reported here together with a brief review of the literature.

Calcified amorphous tumor of the heart with purple digit

A calcified amorphous tumor (CAT) of the right atrium (RA) is an exceedingly rare non-neoplastic cardiac mass. It was initially described in 1997 and only a handful of cases has been published so far. We present a case of tumor in 77-year-old male, in the RA that attached to the rim of the fossa ovalis, with classic pathological and clinical findings. Under cardiopulmonary bypass (CPB) and bicaval and aortic cannulation and cardioplegic arrest, right atrial mass, was resected and septal defect was repaired with a fresh pericardial patch. Pathological exam of the mass revealed CAT. The patient had an uneventful hospitalization and his blue discoloration of finger recovered normally.

A case of cardiac calcified amorphous tumor (cardiac CAT) causing acute embolism in right common iliac artery

A 68-year-old man was admitted to our hospital for the further examination of intermittent claudication. He had been on continuous ambulatory peritoneal dialysis for 2 years. Screening transthoracic echocardiography (TTE) revealed a club-shaped tumor and a round-shaped tumor attached to mitral annulus calcification (MAC). The club-shaped tumor was swinging and plunged into the left ventricle at diastolic phase. Because of the risk of fatal embolism, we planned early surgical resection of the tumors. However, 13 days after admission, his intermittent claudication was getting worse and some part of the club-shaped tumor had vanished by TTE. Urgent iliac angiography showed that the tumor had embolized the right common iliac artery. Although we tried embolectomy using a Fogarty catheter, it was unsuccessful. We therefore treated the iliac artery stenosis by endovascular therapy and the procedure was successful. Three months later, he suffered from unstable angina and was treated by percutaneous coronary intervention. However, subacute stent thrombosis occurred after one month. After urgent treatment, we decided to treat him by coronary artery bypass graft and surgical resection of the residual tumor on MAC. The operation was performed successfully. Finally, the tumor was diagnosed as cardiac calcified amorphous tumor by its histologic features. <Learning objective: Cardiac calcified amorphous tumor (CAT) is a rare, non-neoplastic cardiac tumor. Mobile and pedunculated cardiac CAT is considered to be an important risk of systemic embolism. Based on our case and previous reports we reviewed cardiac CAT, especially MAC-related CAT, and it appears to be related to end-stage renal disease and may grow within a short duration. It is important to perform routine serial echocardiography for hemodialyzed patients in whom MAC has been identified.>.

Calcified amorphous tumor in left atrium presenting with cerebral infarction

Calcified amorphous tumor (CAT) of the heart is an extremely rare cardiac mass. We describe a case of cardiac CAT in a 70-year-old Korean female who presented with acute onset dysarthria and right side weakness. Echocardiography and chest computed tomography revealed a left atrial mass that originated from the interatrial septum. The patient underwent surgical resection and pathologic examination demonstrated CAT. Postoperative course was uneventful and she was followed without recurrence.

Newly developed mobile mass superimposed on mitral annulus calcification in patient with cerebral infarction: Documentation of a unique embolic source

Mitral annulus calcification (MAC) has been recognized as a potent risk factor to cause cerebral infarction. There has been suggested possible linkage between mass on MAC and systemic embolic events. We report a case of cerebral infarction with newly developed mobile mass superimposed on MAC.

A case of mobile and massive calcifications in the left ventricle with unknown etiology

We report a case of mobile and massive calcification in the left ventricle of unknown etiology. The pathophysiology and management of this unique condition is described.

Unusual Presentation Chronic Pulmonary Embolism due to Calcified Right Ventricular Mass

Cardiac calcified amorphous tumors (CATs) can arise in all four chambers of the heart. Cardiac CATs can cause diverse symptoms according to their locations, and mass or embolic effects. Pulmonary emboli arising from cardiac CATs have been reported, but the true incidence is unknown due to their rarity. Herein we report a rare case with diffuse CATs in the right ventricle which caused a calcific pulmonary embolism and right-sided heart failure. Echocardiography, chest non-contrast computed tomography, and cardiac magnetic resonance imaging helped us diagnose the CATs. We recommend the usefulness of a multimodality imaging approach to characterize intracardiac masses and their complications accurately.

Cardiac swinging calcified amorphous tumors in end-stage renal failure patients

We recently encountered 2 patients with mobile cardiac calcified amorphous tumors who were successfully treated by surgery. Both patients had mitral annular calcification and were on hemodialysis. These tumors showed swinging motion on echocardiography and they grew rapidly. Intraoperatively, the tumors were found to be fragile and they easily detached from their origin. The histologic findings were thrombus with angiogenesis, fibrin, and calcium deposition. This rapid-growing mobile tumor in end-stage renal failure patients is speculated to increase the risk of embolic events and should be included as a special entity of cardiac amorphous tumors.

Calcified amorphous tumor of the heart in an adult female: a case report

Introduction

Cardiac calcified amorphous tumor is a rare, non-neoplastic intra-cavity cardiac mass composed of calcium deposits in a background of amorphous degenerating fibrinous material. Only a few cases of this rare lesion have been reported in the available literature. Clinico-pathological differentiation of this lesion from calcified atrial myxoma, calcified thrombi or other cardiac neoplasms is extremely difficult; hence pathologic examination is the mainstay of diagnosis. To the best of our knowledge this entity has not been reported in the Indian literature.

Case presentation

A 40-year-old woman of Indian origin presented with progressive dyspnea, fatigue and cough. She was diagnosed as having a calcified right atrial mass. The mass was excised. Histologic examination revealed the mass to be composed of amorphous eosinophilic fibrin with dense calcification. No myxomatous tissue was seen and a final diagnosis of calcified amorphous tumor of the heart was rendered.

Conclusions

Calcified amorphous tumor is a rare cardiac lesion with an excellent outcome following complete surgical removal. Since clinico-radiologic differentiation from other cardiac masses is not possible in most cases, histopathological examination is the only modality for diagnosis. Hence, histopathologists should be aware of this rare entity in the differential diagnoses of cardiac mass.

Effects of Lowering Dialysate Calcium Concentration on Mineral Metabolism and Parathyroid Hormone Secretion: A Multicentric Study

This prospective study was conducted with the aim of examining the efficacy of lowering dialysate calcium (dCa) in order to: (i) stimulate bone turnover in hemodialysis patients with biochemical signs of adynamic bone disease (ABD) (hypercalcemia, normal alkaline phosphatase and intact parathyroid hormone (iPTH) <150 pg/mL); and (ii) diminish hypercalcemia in patients with secondary hyperparathyroidism (sHPT) (hypercalcemia, high alkaline phosphatase and iPTH > 400 pg/mL), thus permitting the use of calcium-containing phosphorus binders and vitamin D metabolites. Patients were divided into: an ABD-treated group (24 patients), a sHPT-treated group (18 patients), an ABD-control group (12 patients) and a sHPT-control group (11 patients). For the ABD- and sHPT-treated patients, hemodialysis was conducted with dCa 1.5 mmol/L for three months and then with dCa 1.25 mmol/L for an additional three months, while in the control groups hemodialysis was conducted with dCa 1.75 mmol/L during the entire study. Reduction of dCa in patients with ABD caused a slight but insignificant decrease of Ca, but a significant and permanent increase of bone-specific alkaline phosphatase and intact parathyroid hormone level serum levels. Reduction of dCa in patients with sHPT slightly but insignificantly decreased Ca and intact parathyroid hormone level values. Nevertheless, this enabled the calcium-based phosphate binder dose to be raised and vitamin D3 metabolites to be introduced. Logistic regression analysis indicated that milder bone disease (both ABD and sHPT) was associated with more the favorable effect of dCa reduction. Thus, low dCa stimulated parathyroid glands and increased bone turnover in ABD patients, and enabled better control of mineral metabolism in sHPT patients.

Mobile components associated with rapidly developing mitral annulus calcification in patients with chronic renal failure: review of mobile elements associated with mitral annulus calcification

Mitral annulus calcification may directly cause cerebrovascular accidents by serving as a source of calcific or thrombotic emboli. This hypothesis has been supported by recent reports of mobile components associated with mitral annulus calcification detected by echocardiography. Cardiovascular calcifications, including mitral annulus calcification, are common in end-stage renal disease and may develop and progress over a short period of time. We report two patients with mobile components associated with mitral annulus calcification and end-stage renal disease. Serial echocardiography documented that the mitral annulus calcification in these two patients had developed rapidly. Follow-up echocardiography in one patient demonstrated resolution of the mobile elements.