Recurrent ischemic stroke as a result of caseous calcifications of the mitral annulus under dual anti‐platelet therapy

We report on a patient with recurrent ischemic stroke as a result of caseous calcifications of the mitral annulus under dual anti‐platelet therapy. She underwent surgical removal of a calcified mass attached to the posterior mitral valve, and she had no recurrent stroke after surgery. Although mitral annular calcification is usually believed to be benign and at low risk of embolic complications, caseous calcifications of the mitral annulus might be at high risk of embolic stroke and refractory to medical treatment, such as anti‐thrombotic therapy. In patients with ischemic stroke of unknown etiology, thorough examination of uncommon cardiac sources is important. Although there is no established indication of surgical treatment for caseous calcifications of the mitral annulus, surgical removal would be considered when the patients experienced recurrent stroke under aggressive anti‐thrombotic therapy.