Surgical experience with caseous calcification of the mitral annulus: a case report

Figures

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  Figure 1. Preoperative images. (A) Echocardiography showing a hyperechoic mass (arrow) at the posterior leaflet of the mitral valve. (B) Color Doppler echocardiography demonstrating mild mitral regurgitation. (C) A mass lesion (arrows) with an internal hypoechoic core is observed attached to the posterior mitral annulus, accompanied by acoustic shadowing. (D) A protruding lesion (arrow) was observed within the left atrium at the P3 segment of the mitral valve on the reconstructed image. (E) CT showing a calcified mass (arrow) with an internal low-attenuation area. (F) Three-dimensional reconstruction image revealing a mass lesion occupying the posterior mitral annulus (P3 segment).

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  Figure 2. Intraoperative findings. (A) An elastic, hard, and smooth-surfaced protruding mass is observed at the P3 segment of the mitral annulus. (B) After lesion incision, creamy caseous material was discharged from the interior of the lesion. (C) Mitral annulus showing a defect after thorough debridement of the caseous contents. (D) Mitral valve replacement combined with annular reconstruction using an autologous pericardial patch.

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  Figure 3. Histopathological findings (hematoxylin and eosin staining). The specimen showed fine calcified deposits and a foreign body response characterized by neutrophilic and lymphocytic infiltration alongside macrophage clustering. No evidence of bacterial pathogens or malignancy was observed.