添木 武, 福田 信夫, 武市 直樹, 篠原 尚典, 由井 靖子, 田村 禎通

Takeshi SOEKI, Nobuo FUKUDA, Naoki TAKEICHI, Hisanori SHINOHARA, Yasuko YUI , Yoshiyuki TAMURA

国立善通寺病院循環器科・臨床研究部

Department of Cardiology and Clinical Research, Zentsuji National Hospital

キーワード : Left ventricular hypertrophy , Left ventricular outflow pressure gradient , Mitral annulus calcification , Mitral stenosis , Echocardiography

Mitral annulus calcification (MAC) is a common finding in elderly patients, but mitral stenosis (MS) secondary to MAC is rarely observed. We report three patients with left ventricular hypertrophy presenting MS secondary to MAC. All three patients were elderly women. Two patients had hypertrophic obstructive cardiomyopathy, and one had aortic valve stenosis. Echocardiographic features observed in all three patients were (1) hypertrophy of the left ventricular wall, (2) moderate degree of pressure gradient in the left ventricular outflow tract, (3) severe calcification of the posterior mitral annulus with limited mobility of the posterior mitral leaflet, and (4) extended calcification to the anterior mitral annulus. These findings suggest that an increased left ventricular systolic pressure increases stress on the mitral apparatus and may accelerate the development of MAC. We further suspect that MS may result from a reduction of normal annular dilatation during diastole or from the limited mobility of the posterior mitral leaflet caused by severe calcification protruding into the posterior submitral angle.