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Taichi Sakaguchi, Toshinori Totsugawa, Kentaro Tamura, Arudo Hiraoka, Koichi Inoue, Caseous calcification of the mitral annulus, European Heart Journal - Cardiovascular Imaging, Volume 19, Issue 4, April 2018, Page 432, https://doi.org/10.1093/ehjci/jex337
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A 69-year-old woman with no significant medical history came to the emergency department after experiencing transient visual defects. Transthoracic echocardiogram (TTE) findings revealed a large hyper-echoic mass over the posterior mitral annulus (Panel A, Supplementary data online, Video S1). Under a diagnosis of cardiac tumour or thrombus, the patient was referred to our institution for possible urgent removal of cardiac mass. Cardiac computed tomography (CT) was performed upon her arrival, revealing a round hyper-dense mass along the posterior mitral annulus (Panel B), which was consistent with caseous calcification of the mitral annulus (CCMA). As she did not show any recurrent neurological symptoms with no significant findings in her brain CT, she was followed for 4 years until development of shortness of breath. Follow-up TTE and cardiac magnetic resonance imaging confirmed an increase in CCMA size, which was associated with moderate mitral stenosis and mitral regurgitation due to systolic anterior motion of the mitral leaflet (Panel C, Supplementary data online, Video S2). Surgical treatment was performed, during which a creamy white material was removed from the mass (Panel D) and the mitral valve was replaced with a bioprosthetic valve.
