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The cardiac calcified amorphous tumour (CAT), which is originally described by Reynolds and colleagues,1 is a very rare non-neoplasmic cardiac mass. Since only few reports have been published, the cause, clinical manifestations and treatment of this tumour remain unknown.
A previously healthy woman in her 80s presented to the ophthalmology clinic of our institution with a 2-week history of acute painless vision loss in her left eye. Dilated fundus examination of her left eye revealed a visible motile embolus in the branch of the retinal artery bifurcation. A diagnosis of branch retinal artery occlusion was made.
Ttransthoracic and transoesophageal echocardiography and CT angiography (figure 1A–C) demonstrated diffuse calcification affecting the mitral annulus and mitral leaflets and a pedunculated, mobile tumour that originated from the annulus of the posterior leaflet of the mitral valve. The primary and secondary tumours were hyperechoic and measured 19×5 mm and 5×2 mm, respectively. Mitral regurgitation was not detected, and the left ventricle systolic function was not depressed with a volumetric calculated ejection fraction of 65%. ECG revealed normal sinus rhythm and no arrhythmia. Laboratory data showed no evidence of an inflammatory reaction and renal dysfunction.
To prevent any further embolic events, emergency surgery was performed. Considering her general condition, we decided to perform endoscopic tumour resection via right thoracotomy. After the left atrial incision, the mitral valve and tumours were clearly visualised by endoscopy (figure 1D,E and video 1). Although the mitral valve showed a little degenerative change, no evidence of infectious endocarditis was observed. Two soft and fragile tumours were easily removed by using forceps without exerting any force. This patient is alive and well with no evidence of tumour recurrence 6 months after the operation.
Histologically, the lesions were similar and composed of nodular deposits or flecks of calcium within a background of eosinophilic, amorphous and sometimes fibrillar material (figure 2). Based on the pathological findings and the irregularly shaped calcific cardiac mass demonstrated by CT, the patient was diagnosed with a CAT of the heart.
Cardiac CAT is a rare non-neoplastic cardiac mass that mimics malignancy and causes symptoms due to obstruction or embolisation of calcific fragments.1 2 Surgical excision is the treatment of choice in suitable candidates and can be curative. Postoperative recurrence of CAT has been reported, hence patients should be followed vigilantly.3
We presented a case of multiple calcified amorphous tumours of the heart.
Endoscopic tumour resection via a right thoracotomy is safe and feasible, with a potentially improved surgical view.
Postoperative recurrence of CAT has been reported, hence patients should be followed vigilantly.
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Contributors SE was responsible for critical revision of the article, writing, editing and data collection. YM contributed to original drafting, design and implementation of the research, and data collection. AY and MS finalised the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.