ABSTRACT

Caseous calcification of the mitral annulus: A rare malicious pathology

Mitral annular calcification (MAC) is a frequent degenerative process in the elderly population. Caseous calcification of the mitral annulus (CCMA) is a rare and often underdiagnosed MAC variant. It occurs predominantly in elderly women, particularly those with hypertension, chronic kidney disease, or calcium-phosphate metabolism disorders. This paper presents a case of an 82-year-old woman with a history of permanent atrial fibrillation, hypertension, stable coronary artery disease, type 2 diabetes, dyslipidemia and chronic kidney disease, admitted for symptomatic bradycardia and decompensated heart failure (NYHA III). Echocardiography revealed an oval mass at the posterior mitral annulus and inferolateral left ventricular wall, with a central echolucent area surrounded by a hyperechogenic, calcified shell, consistent with mild mitral stenosis and regurgitation. Cardiac magnetic resonance (CMR) confirmed the diagnosis of caseous mitral annular calcification. A differential diagnosis requires multimodality imaging, including echocardiography, computed tomography (CT) and CMR, in order to differentiate between CCMA and infectious, neoplastic or thrombotic etiologies. Although often asymptomatic, CCMA may be associated with conduction abnormalities, valvular dysfunction or, rarely, embolic complications. Surgical treatment is reserved for cases with significant mitral valve obstruction or regurgitation, embolic events, or diagnostic uncertainty.

Piśmiennictwo

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