Caseous Necrosis of the Mitral Valve: Imaging Methods Allow the Diagnosis and Prevent Surgery

Introduction

Calcification of the mitral annulus (CMA) is defined as a chronic degeneration of the mitral annulus fibrous involving mainly the posterior annulus. It is a common condition in the elderly, especially in women, and is associated with hypertension. Caseous necrosis of the mitral valve (CNMV) is a rare and less known CMA variant with a prevalence of 0.64%, which can reach up to 2.7% in autopsy studies of patients with CMA.^–

On echocardiography, CNMV appears as a large rounded or semilunar echodense mass, with a liquid filling and central echolucency, similar to a periannular tumor.^, The mechanism of liquefaction and caseification are still not well understood, but it is believed to occur due to changes in calcium metabolism.

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