Clinical Aspects of Calcification of the Mitral Annulus Fibrosus

CALCIFICATION of the mitral annulus fibrosus has been studied by pathologists¹and is fairly often discovered more or less accidentally during life by radiologists.²Both groups of observers, properly enough, have regarded it as a degenerative change of no clinical significance. Yet such calcification is not entirely without clinical interest and was in part the subject of a recent monograph.³Its occurrence in the older age groups guarantees that it will be associated at least now and then with obvious heart disease⁴; in fact, it has long been known⁵as one variety of those calcifications which cause heart block.⁶ Then too either the calcification itself or the accompanying valvular changes of aging might reasonably be expected to alter cardiodynamics even in the absence of heart block; practically nothing⁷has been written about murmurs in its presence, and prominent authors⁸dismiss it somewhat vaguely as occasionally associated with mitral