Massive myocardial calcification is a very rare finding. Accurate identification and characterization may help the clinicians to determine the etiology and clinical significance. In this case, the diagnostic pathway excluded previous myocardial infarction, myocarditis and calcium-phosphate disorders. A possible dystrophic etiology was considered. There are no standardized imaging features available to classify specific subtypes of intramyocardial calcifications. The relative merits of cardiac computed tomography and magnetic resonance in providing complimentary diagnostic information for calcific myocardial lesions is shown. Knowledge of the potential etiology and their imaging patterns are important to provide a concise and accurate differential diagnosis.

A case of a severe paravalvular mechanical mitral prosthesis leak in a high-risk patient that underwent previously 4 mitral valve surgeries is described. An Amulet-Amplatzer device was correctly implanted on the left atrial appendage, with the temptative to close also the contiguous severe leak. A residual moderate paravalvular leak caused acute hemolysis with severe renal failure requiring hemodialysis. The transesophageal echocardiogram is crucial in localizing and defining the extent of the paravalvular leak. It is not clear if the hemolysis was precipitated by the evolution of the disease or by the residual regurgitation after Amulet device deployment. Certainly, given the intricacy of the procedure the results might be limited also for highly expert operators. To our knowledge, this is the first case reporting the use of the Amulet-Amplatzer device for paravalvular leak closure.