Severe mitral annular calcification in rheumatic heart disea
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Introduction:
Mitral annular calcification (MAC) is a common feature in patients with chronic rheumatic heart disease (RHD), chronic kidney disease, and advanced age. A severely calcified mitral annulus is frequently seen in patients with chronic kidney disease and degenerative valve disease, but it is rare in RHD. We hereby report a case of severe MAC in a chronic RHD patient and discuss the management issues related to it.

Case report:
A 45-year-old female with chronic RHD who was under medical treatment for 2 years, presented with atrial fibrillation and gross congestive heart failure. Her routine serum biochemistry tests, including urea and creatinine, were normal. Two-dimensional echocardiography showed a thickened, calcified, retracted posterior mitral leaflet with severe mitral regurgitation. The posterior mitral leaflet and adjacent mitral annulus were calcified. She improved with diuretics and other supportive treatment. Fluoroscopy in right anterior oblique 30° revealed a “crown”-like severe calcification of the mitral annulus. Her angiography showed normal epicardial coronaries.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312237/
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