Mitral annular calcification. Clinical and echocardiographic correlations.

Clinical, echocardiographic, and radiographic findings in 41 patients with mital annular calcification are presented. Clinical diagnosis included rheumatic heart disease (32%), noninflammatory calcific disease (34%), and chronic renal failure (32%). Mitral annular calcification is recognized echocardiographically as a dense echo band beneath the posterior mitral leaflet with motion paralleling that of the free left ventricular wall. Only two patients of 41 (5%) with mitral annular calcification had calcification on routine x-ray films, and six of 16 (38%) on cinefluoroscopy. The left atrial size is enlarged, and the mitral leaflets are thickened, with reduced motion (D-E) in rheumatic heart disease, but the leaflet motion is well preserved in the nonrheumatic patients. The association of mitral annular calcification with idiopathic hypertrophic subaortic stenosis, chronic renal failure, and bacterial endocarditis is discussed. Echocardiography appears to be a sensitive method of detecting mitral annular calcification and may be helpful in differentiating rheumatic and nonrheumatic etiologies.