Myocardial infarction as the first probable manifestation of caseous calcification of the mitral annulus.

ABSTRACT

Calcification of the mitral annulus is a common echocardiographic finding during routine evaluation of patients. Caseous calcification of the mitral annulus (CCMA) on the other hand is a rare variant, occurring in about 0.06-0.07% of echocardiographic studies. The authors present the case of a 73-year-old woman admitted to hospital with an anterior wall acute coronary syndrome, in whom transthoracic echocardiography showed a well-defined echogenic rounded mass measuring 27 x 22 mm in diameter attached to the posterior mitral annulus. After transesophageal echocardiography and magnetic nuclear imaging, which confirmed the characteristics of the mass, the patient underwent surgical resection of the mass and mitral replacement with a mechanical prosthetic valve. Histological examination confirmed the diagnosis. Systemic embolism associated with CCMA is a rare but possible complication and was probably the cause of the acute coronary syndrome in this patient.