Rapidly progressing, massive mitral annular calcification. Occurrence in a patient with chronic renal failure

Abstract

Calcification of the mitral annulus developed in a patient while undergoing dialysis. The rapid onset of events corresponded to the onset of end-stage renal failure and uncontrolled secondary hyperparathyroidism. Sequential echocardiograms verified the progression of calcification of the annulus as well as the valve. A new systolic and diastolic murmur and reduced valve orifice on 2-dimensional echocardiography suggested acquired nonrheumatic mitral stenosis and insufficiency. Metastatic Ca deposition rather than long-term hypertensive and degenerative effects was the predominant mechanism for massive calcification of the annulus and valve. Apparently M-mode echocardiography can be used sequentially to follow both the occurrence and progression of calcification of the mitral annulus or valve in patients with chronic renal failure, secondary hyperparathyroidism or both.