Caseous Calcification of the Mitral Annulus Causing Multiple Cardioembolic Strokes

Caseous mitral valve calcification and concurrent hypertrophic obstructive cardiomyopathy: A rare cause of stroke

“…It can also lead to the same hemodynamic consequences of constrictive pericarditis. While all these complications significantly increase the risk of CVA, we believe that CCMA independently carries a higher risk of cerebrovascular complications especially in presence of HOCM [1] , [3] , [5] , [6] .…”

“…CCMA is a distinctive and special variant of MAC that results from liquefactive necrosis of the posterior annulus of the mitral valve and is usually considered a benign condition [1] , [2] . In rare cases, however, it may compromise the normal function of the mitral valve, subsequently causing regurgitation or mitral stenosis [3] .…”

“…The suggestive echocardiographic findings of CCMA include areas of decreased echogenicity, a central echolucent zone, and the absence of acoustic shadowing. Microscopically, CCMA is characterized by liquefaction necrosis with amorphous eosinophilic acellular material surrounded by lymphocytes and macrophages amid multiple small calcifications [1] . Intriguingly, only four of the reported 25 (16.0%) patients with CCMA who suffered a CVA had a history of AF.…”

“…Mitral annulus calcification (MAC) is a relatively common condition with a prevalence of about 14%, often seen at old age and results from degenerative changes in the mitral valve fibrous skeleton [1] . An exceedingly rare and adverse variant of MAC is the caseous calcification of the mitral annulus (CCMA), which accounts for only 0.6% of all MAC cases [2] .…”