Calcification of the Left Annulus Fibrosus

Pathological and clinical study of calcification of the mitral valve ring

“…Systolic murmurs were noted in half (Ashworth, 1946) to all (Kom, De Sanchs, and Sell, 1962) patients in the smaller series, and in half to two thirds of the three larger groups (Fertman and Wolff, 1946;Geill, 1951;Simon and Liu, 1954). Indeed, mitral ring calcification is the commonest abnormality found in elderly patients with systolic murmurs (Pomerance, 1968).…”

“…The question is also discussed in recent text-books of cardiology; Friedberg (1966) states that the frequency of clinical abnormalities in mitral ring calcification was due to associated rheumatic or ischaemic heart disease and not to calcium deposition, while Hurst and Logue (1966) state that ring calcification can produce cardiac failure which may be mistakenly diagnosed as rheumatic or ischaemic. Fertman and Wolff (1946) considered mitral ring calcification an indication of other significant cardiac disease but Geill (1951), from his survey of 230 cases, concluded that it was an independent disease process, unrelated to other cardiac abnormalities. The present author's experience confirms Geill's view and also the suggestion of Simon and Liu (1954) that the effect of ring calcification is further impairment of cardiac function in hearts already diseased.…”

Subvalvular calcification of mitral valve.

“…In this case the most usual site is under the posterior mitral leaflet, so that it appears as a small section of arc. This position was noted by Geill (1951) to be usually the initial site of calcification in the mitral ring. On the postero-anterior film the medial part overlies the spine, and the lateral part overlies the main left lower lobe arteries, so that it can be easily missed.…”

“…Because of the reported association with senile osteoporosis (Ipsen, 1934;Geill, 1951), it has been suggested that mobilization of calcium may result in the deposition of calcium in the mitral valve ring and other organs; but it has been shown that the serum calcium and phosphate levels are not altered in osteoporosis so this is probably a fortuitous association. Martens (1932) has emphasized the frequent occurrence of hyperostosis frontalis and calcification of intervertebral discs in association with mitral annulus calcification.…”

“…One of these processes is mitral ring calcification (Fertman and Wolff, 1946;Geill, 1951). It occurs frequently and has been variously ascribed to rheumatic disease, rheumatoid disease, and endocarditis of various aetiologies; it is more generally regarded as an endstage degenerative disorder similar to the Monckeberg type of aortic valve calcification.…”