Pathological and clinical study of calcification of the mitral valve ring

Abstract

SYNOPSIS The pathology and clinical features of 258 cases of mitral ring calcification were reviewed. The overall incidence in patients over 50 years of age was 8-5%; it was more than twice as high in women ([1-5 %) as in men (4-5 %) and rose sharply with age.Cardiac failure and systolic murmurs were each noted in over half the patients. Hypertension was slightly commoner than in age-and sex-matched groups without ring calcification, although the difference was not statistically significant.Small nodules of calcification were more frequent in men and heavy deposits in women. Distortion and atrial displacement of the posterior mitral cusp was present in 26% of the hearts with early ring calcification, in 56% of the hearts with moderate, and in almost all hearts with marked changes. Systolic murmurs had been heard in 73 %of these cases. 'Caseation' of the calcified ring was seen in seven hearts and haemorrhagic valvulitis in three. Calcium had ulcerated through the cusp in 12 cases, with thrombotic and/or bacterial endocarditis in five. Aortic valve calcification was present in 36% of men and was quantitatively related to the severity of mitral ring calcification. In women the incidence was 30 % and there was no corresponding quantitative relationship.Microscopy showed nonspecific chronic inflammatory changes adjacent to calcium in about half the cases in both sexes, with foreign body type giant cells in 60%. Similar inflammatory changes in the valve cusp were almost twice as common in women as in men. There was no evidence that previous endocarditis was responsible for mitral ring calcification, neither did parity influence its incidence. Severe coronary atherosclerosis was unrelated but severe aortic atherosclerosis was commoner in patients with calcified mitral rings. The difference, in women, was statistically significant. The higher incidence of severe degrees of ring calcification, complications, and valvular inflammation in women suggests a sex-determined difference in tissue response in the mitral area. Possible provoking factors apply to both sexes and both left side valves, and such a difference would account for the relative frequency and sex incidence of mitral ring calcification.Calcification of the mitral valve ring is one of Hudson's 'Cardiac pathology ' (1965)

Caseous calcification of the mitral annulus: A multi-modality imaging perspective

“…Histological examination of the inner fluid usually reveals an amorphous, basophilic content, composed of a putty-like admixture of fatty acids, cholesterol, calcium and inflammatory cells, mainly macrophages. 4,6 Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. 7 Surgery should be reserved for cases with severe co-existent mitral valve dysfunction, originating from compromised mitral leaflet coaptation secondary to mitral annulus distortion due to CCMA.…”

Caseous mitral annular calcifications: Multimodality imaging characteristics

“…Mitral annular calcification (MAC) is a commonly encountered phenomenon, and is one of the most common findings in the heart in autopsy series [1] . A variant of this entity is caseous MAC, in which an ovoid, focal mass is found with internal, caseous fluid-like calcifications and debris [2] .…”

Caseous Calcification of the Mitral Valve Annulus Simulating an Intramyocardial Mass at Autopsy

“…The prevalence of CCMA is reported to be 0.6% of mitral annular calcification and 0.06-0.07% of the population referred for echocardiography [2,3]. In autopsy studies, its prevalence rises to 2.7% [1].…”

“…The cyst contents consisted of necrotic material that had a pastry cream-gray appearance ( Figure 1). There was no plane of dissection outside the cyst [1].…”

“…Mitral annular calcification is an asymptomatic chronic degenerative process of the mitral valve, which can occur in the elderly population, associated with atherosclerosis [1]. It may also occur in patients with end stage renal failure or other metabolic disorders that result in abnormal calcium deposition.…”