Caseous calcification of the mitral valve annulus

55 years old female patient developedDeveloped attacks of fainting, initial investigation demonstrated abnormal ECG findings with atrial fibrillation pattern. Additional echocardiography demonstratedcardiac mass.

Caseous calcification of the mitral annulus (CCMA) is a rare form of mitral annular calcification occurring in 0.6% of the cases of MAC ¹.It is a degenerative disorder common in the elderly, in particular women, that typically affects the posterior annulus commissure ¹. This disorder carries a benign prognosis but most of the cardiologists. However, physicians who are not familiar with, and this condition and may misdiagnoseinterpret it as a (benign or malignant) cardiac tumor, vegetation or calcified thrombus ^2,3,4, therefore, a punctual differential diagnosis is required. CCMA rarely may be complicated with mitral valve dysfunction, systemic embolization, or conduction abnormalities ⁵. CCMA may demonstrate dynamic course, it may resolve spontaneously or transform back to an isolated form of simple mitral annulus calcification. However, it may recur even after surgical excision ⁶. Currently, CCMA is managed conservatively except inwhen significant associated mitral valve dysfunctions or associated distant embolic events ⁴.