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

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.