Extensive Mitral Annular Calcification
A 78 year-old lady presented with a prolonged history of increasing exertional dyspnoea associated with lethargy. She had no history of rheumatic fever or infective endocarditis and had been followed up with serial echocardiography over several years with known mitral regurgitation. A chest radiograph demonstrated a C-shaped calcific outline of the mitral annulus with the open part lying adjacent to the left ventricular outflow tract (Fig. 13.1a). Coronary angiography demonstrated no flow limiting coronary artery lesions but marked calcification of the mitral annulus could clearly be visualised during fluoroscopy (Fig. 13.1b).