Nino Marino

Images in cardiovascular medicine. Caseous calcification of the mitral annulus by 64-detector-row computed tomographic coronary angiography: a rare intracardiac mass.

A 70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2⇓). A 2×1.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus …70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2). A 21.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus was noted, without significant coronary artery disease. The patient was managed conservatively. Unlike mitral annular calcification, caseous calcification of the mitral annulus is rare, occurring in fewer than 0.07% of patients undergoing echocardiography, and it is without known clinical significance.1 It is characterized echocardiographically as large, round, tumorlike calcifications, usually on the posterior mitral annulus. Histological analysis reveals a pasty, acellular substance that is culture-negative and free of cancerous or inflammatory cells.2 This is the first reported case of accidentally discovered caseous calcification of the mitral annulus by computed tomographic coronary angiography. Caseous calcification of the mitral annulus should be included in the differential diagnosis of intracardiac masses on computed tomographic imaging.

Caseous Calcification of the Mitral Annulus by 64-Detector-Row Computed Tomographic Coronary Angiography A Rare Intracardiac Mass

A 70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2⇓). A 2×1.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus …70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2). A 21.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus was noted, without significant coronary artery disease. The patient was managed conservatively. Unlike mitral annular calcification, caseous calcification of the mitral annulus is rare, occurring in fewer than 0.07% of patients undergoing echocardiography, and it is without known clinical significance.1 It is characterized echocardiographically as large, round, tumorlike calcifications, usually on the posterior mitral annulus. Histological analysis reveals a pasty, acellular substance that is culture-negative and free of cancerous or inflammatory cells.2 This is the first reported case of accidentally discovered caseous calcification of the mitral annulus by computed tomographic coronary angiography. Caseous calcification of the mitral annulus should be included in the differential diagnosis of intracardiac masses on computed tomographic imaging.

The role of gender in echocardiographically determined left ventricular mass in equally trained populations of runners

8. Severi S, Michaelassi C. Prognostic impact of stress testing in coronary artery disease. Circulation 1991;83(suppl III):III82-8. McArdle WD, Katch FI, Pechar GS. Comparison of continuous and discontinuous treadmill and bicycle tests for max VOs. Med Sci Sports 1973;5:156-60. Balady GJ, Weiner DA, McCabe CH, Ryan TJ. Value of arm exercise testing in detecting coronary artery disease. Am J Cardiol 1985;55:37-41. Lamont LS, Santorelli CG, Finkelhor RS, et al. Cardiorespiratory responses to an air-braked ergometry protocol. J Cardiopulm Rehabil 1988;8:207-12. Stuart RJ, Ellestad MH. National survey of exercise stress testing facilities. Chest 1980;77:94-7. Hagan RD. Gettman LR, Upton SJ, et al. Cardiorespiratory responses to arm, leg, and combined arm and leg work on an air-braked ergometer. J Cardiac Rehabil 1983;3:689-95. Secher NH, Ruberg-Larsen H, Binkhorst RA, et al. Maximal oxygen uptake during arm cranking and combined arm plus leg exercise. J Appl Physiol 1974;36:515-8. Lamont LS, Rupert, SJ, Finkelhor RS, et al. Predicting the oxygen cost of air-braked ergometry. Res Q Exert Sport 1992;63:89-93. Fig. 1. Measured maximal oxygen consumption (VOZ), heart rate, and systolic blood pressure. Data are for combined arm-leg ergometry (A-L) and treadmill (T) testing in the healthy, coronary artery (CAD), and peripheral vascular disease (PVD) subjects, and for all subjects as a whole (TOTAL). *p < 0.05.

Caseous Calcification of the Mitral Annulus by 64-Detector-Row Computed Tomographic Coronary Angiography

A 70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2⇓). A 2×1.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus …70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2). A 21.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus was noted, without significant coronary artery disease. The patient was managed conservatively. Unlike mitral annular calcification, caseous calcification of the mitral annulus is rare, occurring in fewer than 0.07% of patients undergoing echocardiography, and it is without known clinical significance.1 It is characterized echocardiographically as large, round, tumorlike calcifications, usually on the posterior mitral annulus. Histological analysis reveals a pasty, acellular substance that is culture-negative and free of cancerous or inflammatory cells.2 This is the first reported case of accidentally discovered caseous calcification of the mitral annulus by computed tomographic coronary angiography. Caseous calcification of the mitral annulus should be included in the differential diagnosis of intracardiac masses on computed tomographic imaging.

Subxiphoid Pericardiotomy-Reply

In Reply.— The experience of Breyer and associates supports our impression that subxiphoid pericardiotomy is a procedure of choice for the treatment of acute cardiac tamponade. It is of particular note that these authors report one patient with a small right ventricular laceration from an attempted, but unsuccessful, pericardiocentesis. No complications from subxiphoid pericardiotomy occurred. The shorter drainage time reported by Breyer et al underscores the need to individualize removal of the catheter based on the quantity of daily drainage. We routinely remove the catheter when less than 30 mL of fluid has been drained during a 24-hour period. It is apparent from the data provided by Breyer et al that our population, which contained more uremic patients, experienced a much greater quantity of drainage fluid of from 300 to 3,400 mL (average, 1,133 ±192 mL). The longer drainage periods were not unexpectedly associated with the cases of highest fluid