Case Report|Articles in Press

Caseous calcification of the mitral annulus presenting as recurrent strokes

Published:January 07, 2023DOI:


      Although caseous calcification of the mitral annulus is usually diagnosed incidentally, it can cause embolic complications. The current report describes the case of caseous calcification revealed by recurrent episodes of stroke in a 64-year-old female patient. After her last ischemic episode, cerebral magnetic resonance imaging confirmed the presence of a thrombus in the right middle cerebral artery. Transthoracic echocardiogram revealed calcification of the mitral annulus and an echo-dense mass with mobile borders fixed posteriorly. Transesophageal echocardiogram allowed better evaluation of the lesion. A medical approach was preferred, with no recurrence thereafter.

      Learning objective

      Caseous calcification of the mitral annulus is a rare form of mitral annular calcification which is associated with high risk of strokes.
      Medical management with optimal anticoagulation can be effective over long-term follow up.


      MAC (Mitral annulus calcification), CCMA (Caseous calcification of the mitral annulus), TOE (Transesophageal echocardiographic evaluation), CT (Computed tomography), MRI (Magnetic resonance imaging), TTE (Transthoracic echocardiogram), AV (Atrioventricular)


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