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