Severe cases of caseous annular calcification cause which of the following?

• A. Mitral regurgitation
• B. LVOTO
• C. Aortic stenosis
• D. Pulmonary hypertension

Answer: (B)

Caseous calcification of the mitral annulus is a bulky, cheeselike calcified mass in the posterior mitral annulus. When this mass becomes severe, its size and position near the left ventricular outflow tract can cause physical obstruction of the flow from the left ventricle into the aorta during systole. That dynamic narrowing is the reason LV outflow tract obstruction can occur in severe cases. While mitral regurgitation can be a consequence if the annulus is distorted enough to affect leaflet coaptation, and embolic or other issues are possible, the key problem in severe cases is obstruction of the LVOT. Aortic stenosis and pulmonary hypertension are not direct results of a mitral annulus mass.