Department of Cardiology and Clinical Research, Zentsuji National Hospital
Left ventricular hypertrophy , Left ventricular outflow pressure gradient , Mitral annulus calcification , Mitral stenosis , Echocardiography
Mitral annulus calcification (MAC) is a common finding in elderly patients, but mitral stenosis (MS) secondary to MAC is
rarely observed. We report three patients with left ventricular hypertrophy presenting MS secondary to MAC. All three patients
were elderly women. Two patients had hypertrophic obstructive cardiomyopathy, and one had aortic valve stenosis.
Echocardiographic features observed in all three patients were (1) hypertrophy of the left ventricular wall, (2) moderate degree
of pressure gradient in the left ventricular outflow tract, (3) severe calcification of the posterior mitral annulus with limited
mobility of the posterior mitral leaflet, and (4) extended calcification to the anterior mitral annulus. These findings suggest that
an increased left ventricular systolic pressure increases stress on the mitral apparatus and may accelerate the development of
MAC. We further suspect that MS may result from a reduction of normal annular dilatation during diastole or from the limited
mobility of the posterior mitral leaflet caused by severe calcification protruding into the posterior submitral angle.