ABSTRACT
Mitral annulus calcification has been associated with embolic events, but the precise pathophysiology has not been elucidated. The authors describe four patients who experienced embolic events whose transesophageal echocardiograms showed a mitral annulus calcification, with a mobile component that exhibited the same echogenicity as the calcification. Three patients had no other conditions known to be associated with embolism. On follow-up transesophageal echocardiography, the mobile component of the mitral annulus calcification had disappeared in three patients. These findings support the hypothesis that mitral annulus calcification not only is associated with but also is possibly a direct cause of embolic events in some patients.
Subject(s)
Calcinosis/complications , Embolism/etiology , Heart Valve Diseases/complications , Mitral Valve/pathology , Aged , Echocardiography , Female , Humans , Risk FactorsABSTRACT
A 58-year-old patient with dilated cardiomyopathy underwent implantable cardioverter defibrillator (ICD) implantation. The postoperative course was complicated by perforation of the right ventricular free wall by the active fixation transvenous ICD lead. The type of ICD lead and the type of organic heart disease are apparently important risk factors for perforation.
Subject(s)
Cardiomyopathy, Dilated/therapy , Defibrillators, Implantable , Electrodes, Implanted , Heart Injuries/diagnosis , Heart Ventricles/injuries , Wounds, Penetrating/diagnosis , Equipment Failure Analysis , Heart Injuries/surgery , Humans , Male , Middle Aged , Reoperation , Risk Factors , Wounds, Penetrating/surgeryABSTRACT
This study tests the hypothesis that mitral annular calcium (MAC) detected by transthoracic echocardiography (TTE) is a marker for high prevalence and severity of coronary artery disease (CAD) in patients undergoing coronary angiography. Pathological studies have suggested that there is an association between MAC and calcific deposits in coronary arteries; however, there are no clinical data to support this association. One hundred sixty-five patients with MAC (101 women and 64 men; mean age 71 +/- 8 years) who underwent cardiac catheterization with coronary angiography for various reasons were compared with 147 age-matched controls without MAC who underwent coronary angiography for the same indications during the same period. MAC was defined as a dense, localized, highly reflective area at the base of the posterior mitral leaflet detected by TTE. Obstructive CAD was defined as either > or = 50% reduction of the internal diameter of the left main coronary artery or > or = 70% reduction of the internal diameter of the left anterior descending, right coronary, or left circumflex artery distribution. Compared with controls, the MAC group had a significantly higher prevalence of CAD (89% vs 75%, p = 0.001) and higher rates of 3-vessel disease (45% vs 24%, p = 0.001) and left main CAD (13% vs 5%, p = 0.009). Nonsignificant CAD was more common in the control group (25% vs 11%, p = 0.001). Multivariate analysis identified MAC (p = 0.0002), indications for cardiac angiography (p = 0.02), sex (p = 0.03), and diabetes mellitus (p = 0.03) as independent predictors for the presence and severity of obstructive CAD. MAC detected by TTE may be a marker for high prevalence and severity of CAD in patients undergoing coronary angiography.
Subject(s)
Calcinosis/diagnostic imaging , Coronary Disease/pathology , Heart Valve Diseases/diagnostic imaging , Mitral Valve/diagnostic imaging , Adult , Aged , Aged, 80 and over , Biomarkers , Calcinosis/complications , Coronary Angiography , Coronary Disease/classification , Coronary Disease/complications , Echocardiography , Female , Heart Valve Diseases/complications , Humans , Male , Middle Aged , Multivariate Analysis , Prevalence , Risk Factors , Severity of Illness Index , Sex FactorsABSTRACT
Significant association was found between the presence of mitral annular calcium (MAC) and aortic atheroma detected by transesophageal echocardiography. MAC may be an important marker for aortic atherosclerosis.
Subject(s)
Aortic Diseases/complications , Aortic Diseases/diagnostic imaging , Arteriosclerosis/complications , Arteriosclerosis/diagnostic imaging , Calcinosis/complications , Calcinosis/diagnostic imaging , Echocardiography, Transesophageal , Mitral Valve/diagnostic imaging , Adult , Aged , Aged, 80 and over , Female , Heart Valve Diseases/complications , Heart Valve Diseases/diagnostic imaging , Humans , Male , Middle AgedABSTRACT
The HLA typing profile of 26 Israeli subjects with recurrent aphthous stomatitis (RAS) was examined and compared with that of 100 healthy control subjects. HLA-B51 was found in six subjects (23%) with RAS and in nine control subjects (9%) (p < 0.05). HLA-Cw7 was found in six subjects with RAS (23%) and in five control subjects (5%) (p < 0.01). Eleven subjects had first-degree relatives who had RAS. Because a high frequency of HLA-B51 has been found in Behcet's syndrome and aphthous stomatitis is part of this syndrome, it is suggested that in some subjects with RAS the entire syndrome may actually develop in the future.
