Resection of a Mitral Valve Tumor
The patient is a 61-year-old man with a 10-year history of end-stage renal disease secondary to diabetes mellitus who is currently on hemodialysis. He was referred from an outside hospital for resection of a tumor associated with the mitral valve, which was discovered incidentally on echocardiography. He is clinically asymptomatic and denies chest pain or shortness of breath.
Physical exam reveals a chronically ill-appearing 61-year-old man in no distress. Blood pressure is 170/85 mm Hg, pulse is 88 beats per minute, and respiratory rate is 20 breaths per minute. Lungs are clear to auscultation bilaterally. Chest shows scars on the anterior chest wall from previous vascular access sites. Cardiac exam reveals a nondisplaced point of maximum impulse with normal S1 and S2 and an S4 gallop. There is a faint 2/6 holosystolic murmur in the left lower sternal border that does not radiate. See Videos 43-1 to 43-5.
QUESTION 1. The most likely diagnosis is:
A. Mitral valve endocarditis with mitral annular abscess
B. Caseous calcification of the mitral valve annulus
C. Left atrial myxoma
D. Mitral valve papillary fibroelastoma
E. Mitral valve prolapse
View Answer
ANSWER 1: B. The transthoracic echocardiogram demonstrates evidence of a large calcific mass along the posterior aspect of the mitral annulus. There is central echolucency, consistent with the diagnosis of caseous calcification of the mitral annulus. There is normal function of the mitral valve with mild mitral regurgitation and very mild mitral stenosis.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
