Caseous calcification of the mitral valve annulus


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. However, physicians who are not familiar with this condition and may interpret 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 when significant associated mitral valve dysfunctions or associated distant embolic events 4.


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