Approach to An Unusual Cardiac Mass: Mitral Annulus Caseoma

Abstract Caseous calcification of the mitral annulus (CCMA) is known to be a rare variant of mitral annulus calcification, a chronic and degenerative process of the mitral valve fibrous ring. It usually carries a benign prognosis. The following case demonstrates a huge mitral annulus caseoma that complicated with severe mitral regurgitation and was treated with a successful surgery. The common consensus on the optimal management of CCMA is conservative medical management and avoiding unnecessary surgery. Therewithal, the current indications for surgical intervention include mitral valve dysfunction, strokes and uncertain diagnosis. Aggressive debridement, risk of left ventricular perforation and exposure of caseous debris to the systemic blood flow may increase the risk of a standard mitral valve surgery. Mitral valve replacement should be preferred compared with mitral valve repair.

【摘要】二尖瓣环干酪样钙化（Caseous calcification of the mitral annulus, CCMA）是二尖瓣环钙化的罕见亚型，而二尖瓣环钙化属于二尖瓣纤维环的慢性退行性病变，通常预后良好。下述病例为一例巨大二尖瓣环干酪样瘤，该病变并发重度二尖瓣反流，并经成功手术治疗。目前学界对于CCMA的最优管理共识为采取保守药物治疗，规避不必要的手术。此外，当前手术干预的指征包括二尖瓣功能异常、脑卒中及诊断不明的情况。彻底清创可能带来左心室穿孔风险，且干酪样碎屑暴露于体循环血流，会提升标准二尖瓣手术的风险。相较于二尖瓣成形术，二尖瓣置换术应为更优选方案。