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case_images: Transoesophageal echocardiography imaging of caseous calcification of the mitral annulus. The arrow indicates the mass-like appearance of caseous calcification of the mitral annulus.
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case_images: At 52 years of age, transoesophageal echocardiography (TEE) showed CCMA and MR due to calcification of P3 scallop of the posterior leaflet (Figure 1).
case_images: Surgical image (left) and surgical specimen of caseous calcification of the mitral annulus (right). Left: The arrow indicates a cement-like substance of the calcified lesion. Right: Histologically degenerative material with calcification is observed.
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case_images: Surgical findings revealed that the posterior leaflet had a calcified lesion on the ventricular side; when this area was excised, a cement-like substance was observed extruding from within the calcification (Figure 2).
case_images: Computed tomography images after the first surgery. Left: Residual calcification (arrow) is visible outside the prosthetic valve. Right: Residual calcification is observed lateral (solid arrow) and posterior caudal (dashed arrow) to the prosthetic valve.
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case_images: Calcification lateral and posterior caudal to the mitral valve were intentionally left in place to prevent heart rupture (Figure 3).
case_images: 3D transoesophageal echocardiography. (A) Para-valvular leakage. (B) Closed stuck valve. (C) Thrombus.
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case_images: It was unclear whether a leaflet was stuck from the surgeon's view, and the TEE evaluation before the cardioplegia showed that the mechanical valve disc was stuck closed (Figure 4); therefore, thrombus removal alone would be insufficient, which necessitated valve re-replacement.
case_images: Explanted prosthetic valve. An organized fibrin thrombus (arrow) and pannus formation on both hinges on the ventricular side are observed.
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case_images: Pannus formation was observed on both hinges on the ventricular side of the explanted prosthetic valve (Figure 5).