CASE 2—2012 Intraoperative Diagnosis and Management of Caseous Calcification of the Mitral Annulus

Caseous Calcification of the Mitral Annulus: A Review

“…The mass rarely extends along the whole mitral annulus (Figure ) . On the contrary, MAC appears as a J‐, C‐, or U‐shaped dense echo band, which creates an acoustic shadowing and lacks the echolucent center . On color Doppler, the central zone of CCMA lacks any flow …”

“…CCMA appears as a mass with a central area of echolucency resembling liquefaction, with no flow in the central zone by color Doppler, surrounded by a hyperechogenic structure. It may have the appearance of a mass with “string of pearls‐like” appearance …”

“…It lacks the calcifications in the borders that are seen in CCMA. Additionally, it is highly vascular compared with CCMA, in which no blood flow should be visualized by color Doppler …”

“…In hemangiomas, the echolucencies (representing the tumor vascularity) extend all the way to the periphery of the mass and no calcification is found. However, leiomyosarcoma rarely shows echolucencies in the areas of necrosis and calcification …”

A 65 Year-old Woman with an Echodense Mitral Annular Mass

“…Surgery with mitral valve replacement rather than repair is indicated in the event of significant valve dysfunction, embolic manifestations or when the diagnosis of tumour cannot be safely excluded. Finally, anticoagulation should be considered in patients with secondary embolic manifestations [10].…”