Mitral Annulus Caseous Calcification: Not A Conundrum with Cardiac Computerized Tomography

Abstract

A 58-year-old woman with atrial fibrillation was referred for mitral valve replacement due to mitral valve mass on echocardiography. Transesophageal and transthoracic echocardiography showed an echogenic, round mass attached to the basal portion of the posterior mitral valve, mild degeneration of both mitral leaflets and moderate mitral regurgitation. Cardiac computerized tomography (CT) was planned to further assess the mass and its relationship with the mitral apparatus. Cardiac CT showed densely calcified caseous thickening of the mitral annulus that was measured 32 x 13 mm and encircling the posterior mitral annulus which protruded towards the posterior leaflet without disruption of the mitral apparatus. The heart team assessed the patient with integrated findings of transesophageal echocardiography and cardiac CT and decided to manage conservatively.