ABSTRACT
A 35-year-old man was followed up for systemic lupus erythematous with antiphospholipid antibody-positive. He underwent an echocardiogram for a closer examination of his heart murmur. Transthoracic echocardiography revealed a calcified mass of 30 mm in diameter in the right ventricular outflow tract. Surgery was performed through an upper hemi-sternotomy. After establishment of beating-heart cardiopulmonary bypass, the pulmonary trunk was opened with a longitudinal incision. The highly calcified mass was located immediately below the pulmonary valve. We exfoliated the mass from the right ventricle, and resected it en bloc during short-term cardiac arrest. The postoperative pathological diagnosis was a calcified amorphous tumor. The patient was discharged from our hospital on postoperative day 12．No tumor recurrence was observed 9 months after the surgery.
ABSTRACT
We report a rare case of a hemodialysis patient with calcified amorphous tumor (CAT) originating from aortic valve cusp that continues to tricuspid valve, which may be related to aortic annular calcification and aortic valve stenosis. A 79-year-old female with chronic kidney disease on hemodialysis for 16 years was transferred to our hospital with loss of consciousness. Echocardiography revealed aortic valve stenosis and presence of tumor on the aortic valve and tricuspid valve. We suspected the presence of a cardiac tumor or vegetation. We underwent tumor resection of tricuspid valve and aortic valve replacement and coronary artery bypass grafting (SVG-RCA). Pathological findings of the tumor was CAT.
ABSTRACT
We report the case of a 62-year-old man who was admitted for acute cerebral infarction linked to a cardiac calcified amorphous tumor (CAT). The patient, who had been on hemodialysis for about 10 years, was referred to our hospital with dysarthria, and left hemiplegia. Brain magnetic resonance imaging (MRI) showed acute cerebral infarction in right parietal lobe of the cortex, and transthoracic echocardiography revealed moderate aortic valve stenosis and a mobile mass measuring 8 mm×5 mm in diameter attached to the aortic valve. The mobile structure was thought to be related to the cerebral infarction. Aortic valve replacement was performed. On the basis of the pathological examination, a cardiac calcified amorphous tumor was diagnosed. The patient was discharged from our hospital without any complication.
ABSTRACT
Calcified amorphous tumor (CAT) is a non-neoplastic mass characterized by calcified nodules that was first reported in 1997. It is often associated with dialysis or mitral annular calcification (MAC). CAT is considered a risk factor for systemic embolism, but there has been no report of CAT damaging the native valve tissue and leading to valvular disease. An 81-year-old woman had shortness of breath on exertion starting 1 year previously, and was referred to our hospital with cardiac murmur detected on physical examination. Echocardiography showed evidence of severe mitral valve regurgitation with ruptured chordae tendineae of the posterior leaflet and a poorly mobile club-shaped structure protruding into the left ventricle and appearing to be continuous with MAC. She underwent elective mitral valve repair. A club-shaped calcification originating from MAC was found under the P2 segment, with ruptured P2 chordae tendineae immediately above it and mitral perforation in the contralateral A2 segment, which were likely to have resulted from direct damage by the hard structure. Mitral valve repair was successful with mass resection, triangular resection of the posterior leaflet P2 segment, and closure of the perforation. Histopathological findings of the mass were consistent with CAT, with no evidence of infection or malignancy. CAT may not only cause embolism but also grow while damaging the native valve tissue. It is important to closely follow-up and perform surgery in proper timing.
ABSTRACT
<p>Calcified amorphous tumor (CAT) is a non-neoplastic cardiac mass composed of nodules of calcium with a background of amorphous fibrous material and was first described in 1997. This report describes a 61-year-old man, who had been on hemodialysis for 10 years and was referred to our hospital with a diagnosis of acute myocardial infarction. He had percutaneous coronary intervention (PCI) for stenosis of the left anterior descending artery (LAD). He was hospitalized and under medical treatment. A follow-up echocardiogram was performed and revealed a normal ejection fraction of 0.60. Moderate mitral annular calcification with mild-to-moderate mitral stenosis was seen. An ultrasound-mobile mass was visualized in the left ventricular outflow tract (LVOT). There was no hemodynamic evidence of LVOT obstruction on Doppler echocardiography. Transesophageal echocardiography showed a mobile mass attached to the LVOT in the mitral valve annulus that extended almost to the membranous septum. Due to the mobility of the mass and potential for embolism, surgical removal was advised. Concomitant procedures (coronary artery bypass grafting (CABG) and a full maze operation) were proposed because he still had symptoms of chest pain with myocardial ischemia and palpitations due to chronic atrial fibrillation. Surgery was performed through a median sternotomy on cardiopulmonary bypass. After aortic cross-clamping, the mass was approached through a horizontal incision in the ascending aorta. The white tumor was resected easily from the membranous septum. The operation was finished after CABG and a full maze procedure, and his clinical course was uneventful. Histological examination showed that the tumor contained many calcified nodules and fibrino-sanguineous deposits ; these findings are compatible with CAT.</p>