# Surgical management for caseous calcification of mitral annulus associated with coronary artery disease

## TL;DR

This paper presents a safer surgical approach for treating caseous calcification of the mitral annulus in a patient with coronary artery disease.

## Contribution

The novel contribution is a surgical technique that avoids extensive excision, reducing stroke risk while preserving mitral valve function.

## Key findings

- A limited incision and drainage approach was used successfully in a patient with CCMA and coronary artery disease.
- The technique preserved mitral valve function and avoided perioperative stroke.
- Imaging features of CCMA were highlighted to aid in diagnosis and surgical planning.

## Abstract

Mitral annular calcification (MAC) is a common finding, especially among the elderly or patients undergoing haemodialysis. Caseous calcification of the mitral annulus (CCMA) is a rare MAC variant with liquefied material at the calcified annulus. Surgical management of CCMA often involves wide excision and debridement, increasing the risk of perioperative stroke. We report a patient undergoing haemodialysis who developed an enlarged MAC, moderate mitral insufficiency and multivessel coronary artery disease. This case highlights the characteristic imaging features of CCMA. We performed a limited incision for complete drainage, followed by suture obliteration of the cavity and mitral valve repair, in conjunction with coronary artery bypass grafting. This technique was safe, preserved mitral valve function and was not associated with perioperative stroke. We herein report this approach reduces the risk of stroke while maintaining mitral valve function, offering a safer alternative to extensive excision.

Caseous calcification of the mitral annulus (CCMA) is a rare form of mitral annular calcification (MAC), characterized by a toothpaste-like mass enclosed within the annular region.