|An Iceberg in the heart: A calcified amorphous tumor of mitral valve|
|Burak Onan, Mehmet Karacalılar, Serdar Başgöze, Korhan Erkanlı|
|Department of Cardiovascular Surgery, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey|
Calcified amorphous tumor (CAT) is a rare and benign pathology which is composed of calcified nodules on a background of a degenerative and inflammatory amorphous fibrous material.[1-3] Although the pathogenesis of cardiac CAT is unknown, abnormal calcium-phosphorous metabolism, particularly in renal failure, is suspected. Differential diagnosis includes benign/malignant cardiac tumors such as a myxoma, teratoma, or rhabdomyoma, thrombosis, and vegetations.
Herein, we report a 67-year-old case who underwent mitral valve surgery through a transseptal incision with a favorable outcome. During operation, we observed that the anterior leaflet of the mitral valve and its subvalvular apparatus were calcified and presented as a giant tumor (Figure 1). After resection of the calcified leaflet, the annulus of the mitral valve was reconstructed using a pericardial patch, and the valve was successfully replaced with a mechanical prosthesis.
Figure 1: (a) An intraoperative view showing extensive calcification of the anterior leaflet of the mitral valve with decreased mobility of the leaflet, leading to severe insufficiency. (b) An intraoperative view after resection of the valve showing dense calcification in the periannular area of the anterior mitral leaflet. (c) A macroscopic view of the resected mitral leaflets. (d) A histological view of the specimen showing the presence of the calcified nodules in an amorphous background of fibrin and dense inflammation with macrophages and plasma cells (H-E x 200).
Declaration of conflicting interests
1) Kawata T, Konishi H, Amano A, Daida H. Wavering
calcified amorphous tumour of the heart in a haemodialysis
patient. Interact Cardiovasc Thorac Surg 2013;16:219-20.
2) Prifti E, Kajo E, Krakulli K, Ikonomi M. Surgical excision
of a giant calcified amorphous tumour of the right ventricle
and right pulmonary artery. Interact Cardiovasc Thorac
2) Prifti E, Kajo E, Krakulli K, Ikonomi M. Surgical excision of a giant calcified amorphous tumour of the right ventricle and right pulmonary artery. Interact Cardiovasc Thorac Surg 2015;21:805-7.