ABSTRACT

A 78-year-old woman with a history of hypertension, diabetes mellitus and chronic obstructive pulmonary disease was admitted for dyspnea uponminimal exertion.Herwhite blood cell countwas normal, erythrocyte sedimentation rate and CRP levelswereminimally elevated. PA chestX-ray showed massive pleural effusion at right hemithorax and elevated cardiothoracic rate. Transthoracic echocardiography (TTE) showed a large calcified mass of 27 × 24mmin the posteriormitral annulus that extended to the most basal area, the P1–P2 scallops, without causing valve stenosis (E velocity: 1,1 m/s) (Fig. 1) and with moderate mitral regurgitation (Fig. 2). Left atrial chamber and right heart chambers were dilated, left ventricular ejection fraction was 46% (modified Simpson) on echocardiographic evaluation. The patient was offered for transesophageal echocardiography, but patient refused invasive cardiac procedures. During the follow-up period, the patient was treated with supportive medical treatment.