The Journal of Cardiothoracic and Vascular Anesthesia has recently published online ahead of print a new case report co-authored by UF Department of Anesthesiology faculty members Joseph AbuRahma, M.D., Chris Goldstein, M.D., and Albert Robinson III, M.D., along with colleagues from the Divisions of Cardiovascular Medicine and Cardiovascular Surgery: John Spratt, M.D., Tomas Martin, M.D., Eric Pruitt, M.D., and Tom Lewandowski, M.D.
This article, titled “Caseous Calcification of the Interventricular Septum Leading to Left Ventricular Outflow Tract Obstruction in the Setting of a Normal Mitral Valve Annulus,”details the unique complications and treatment of a 66-year-old patient with severe aortic stenosis, a normal mitral valve, and a mass in his interventricular septum with caseous calcification of the mitral annulus (CCMA). CCMA is a very rare type of mitral annular calcification, affecting only about 0.06% of the population. It is usually detected through echocardiography, where it appears as a large, dense mass, and is characterized by calcification within the heart muscle with central areas that look like liquefaction.
CCMA can lead to several complications that can create significant challenges for anesthesiologists, including strokes and acute coronary syndrome. It can also lead to left ventricular outflow tract obstruction, which restricts blood flow from the left ventricle to the rest of the body and is associated with various structural heart abnormalities.
After removing the caseous calcification mass, the surgical team replaced the patient’s aortic valve and provided postoperative care that included placing a dual-chamber permanent pacemaker. The patient was discharged home nine days after the surgery.
“The presence of caseous calcification in the absence of mitral annular calcification, or its association with aortic stenosis, has rarely been described” the authors stated. “This case depicts a unique clinical pathology and may aid in the prevention of misdiagnosis of cardiac masses.”
Congratulations to Drs. AbuRahma, Goldstein, and Robinson, and their co-authors!