Learning Radiology xray montage

Mitral Annulus and Leaflet Calcification

  • Mitral annulus frequently calcifies over the age of 60
    • One of the most common cardiac calcifications
    • Has been considered to be a degenerative process
    • Calcification is actually subvalvular in location
    • Associations
      • Aortic stenosis
      • Hypertrophic cardiomyopathy
      • Chronic renal failure, especially of those on dialysis
      • Bacterial endocarditis
      • Systemic hypertension
      • Diabetes mellitus
      • Hypercholesterolemia
    • It may be associated with significant atherosclerosis
    • In one study, it was found to be associated with twice the risk of stroke, independent of other risk factors
    • In another study, it was associated with an increased prevalence of coronary artery disease in patients <65
    • Calcific deposits can lead to cardiac conduction disturbances
    • Usually occurs over the age of 40, more often after 65-70
    • More common in women
    • Not clinically significant unless massive
      • May lead to mitral insufficiency
    • Shaped like a U, J or reverse C
    • Appears as a band of increased density
    • Echocardiography and CT are most sensitive means of imaging it
  • Mitral leaflet calcifications
    • Formerly calcification of the mitral valve itself was most commonly due to rheumatic fever
      • Rheumatic fever produces valve abnormalities leading to stenosis and regurgitation, including:
        • Calcification and thickening of leaflets and chordae tendineae
        • Fusion of commissures
    • Can also occur as a degenerative process
      • Prevalence increases with age
      • Found in 75% over age 80 on CT
      • Not associated with mitral stenosis
        • Whereas aortic valve calcifications are invariably associated with aortic stenosis
    • When rheumatic in origin, mitral valve calcification is usually associated with mitral stenosis
    • Imaging findings
      • Heavier calcific deposits in men than women
      • Not usually apparent on conventional radiography
      • Calcium usually deposited in clumps on valve leaflets
      • On a lateral chest radiograph, a line drawn connecting the carina and the anterior costophrenic sulcus will usually mark the location of the aortic valve above and the mitral valve below


Calcification of the Mitral Annulus . The blue arrows point to dense, amorphous calcification
arranged in a curvilinear path that corresponds to the location of the annulus of the mitral valve.

For the same photo without the arrows, click here