Large Caseating Calcification of the Mitral Valve Ring
An 89-year-old woman presented with angina pectoris and troponin activation, indicating the occurrence of a non-ST-segment elevation myocardial infarction. Coronary angiography showed a coronary 3-vessel disease and a contraction-synchronous radiopaque structure approximately 2 × 3 cm in size projected onto the right atrium. Echocardiography carried out after percutaneous coronary intervention demonstrated a probably extracardial echo-dense structure in the area of the posterior mitral valve ring. Subsequent computed tomography with intravenous administration of contrast medium found a 3 × 3 × 4 cm saucer-shaped calcified mass (→) with hyperdense content (*), a “caseating calcification of the mitral valve ring”. These calcifications typically manifest in elderly women as a rounded, smoothly delineated mass (→) of the posterior mitral valve ring, calcified on the periphery, with central liquid necrosis (*). This represents a rare form of mitral annular calcification of uncertain pathophysiology. Because the caseating calcification of the mitral valve ring caused no symptoms (mitral valve failure/stenosis, cardiac arrhythmias, systemic emboli) in our patient, no treatment was given in this regard.
PD. Dr. med. Kai Nassenstein, Universitätsklinikum Essen, Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, firstname.lastname@example.org
Dr. med. Moritz Lambers, PD. Dr. med. Oliver Bruder, Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Klinik für Kardiologie und Angiologie
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Nassenstein K, Lambers M, Bruder O: Large caseating calcification of the mitral valve ring. Dtsch Arztebl Int 2020; 117: 194. DOI: 10.3238/arztebl.2020.0194a