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Caseous Calcification of the Mitral Annulus
CCMA

General Considerations

Mitral annular calcification is found in 10% of patients > than 50 years of age, most often in women
It is a chronic degenerative process almost always asymptomatic
Represents deposition of calcium between the basal infero-lateral ventricular wall and posterior leaflet of mitral valve
Caseous calcification of the mitral annulus is an uncommon variant of mitral annular calcification with a characteristic appearance
Represents a mixture of calcium, cholesterol and fatty acids

Clinical Findings

Patients are usually asymptomatic
Most are older and almost all have systemic hypertension

Imaging Findings

Large, spherical calcification that may have sonolucent center on echo
On MRI, it is of low signal intensity on both T1 and T2-weighted images before and after contrast.
Usually located on the posterior mitral leaflet
Contains putty-like, “toothpaste-like” material surrounded by a calcified shell

Differential Diagnosis

Benign prognosis not to be mistaken for tumor which is in the differential diagnosis

Prognosis

There are reported cases in which the calcification spontaneously disappeared on follow-up and in another case presumably resolved related to hemodialysis

Caseous Calcification of the Mitral Annulus. Post-contrast enhanced CT axial and coronal scans through the heart show a large, lobulated calcification at the site of the mitral valve (white arrows) representing the characteristic appearance of caseous calcification of the mitral annulus.
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Caseous Calcification of the Mitral Valve Ring. Marcu , C, Ghantous, A and Prokop, E. Lung and Circulation. Volume 15, Issue 3, June 2006, Pages 187-188.

Caseous Calcification of the Mitral Annulus. H Arora; P Madan; L Simpson and R Stainback. Tex Heart Inst J. 2008; 35(2): 211–213. 2008

Cardiovascular magnetic resonance features of caseous calcification of the mitral annulus. L Monti; E Renifilo; M Profili and L Balzarini. Cardiovasc Magn Reson. 2008; 10(1): 25.