Calcification of the mitral annulus fibrosus with systemic embolization. A clinicopathologic study of 16 cases

A review of 1343 autopsies on patients over the age of 40 years revealed 142 patients with calcification of the mitral annulus fibrosus, representing 10.6% of the studied population. Sixteen patients (11.3%) had systemic calcareous embolization. Eight patients showed clinical symptoms reflecting embolization, while the others did not. Three of the patients with clinical manifestations had been admitted to the hospital with a history of a fall and two of these, whose postmortem examination included the brain, showed focal meningitis due to embolization from an infected calcified mitral annulus fibrosus. Another three patients had been admitted to the hospital with a clinical diagnosis of cerebral vascular accident and were found to have focal ischemic necrosis or large cerebral infarcts. These were the result of either calcareous or bland embolization from a thrombus superimposed on an ulcerated calcified annulus. Eight of the 16 patients with calcareous embolization also had had sepsis, six attributable to infective endocarditis complicating the calcified mitral annulus fibrosus. This study suggests the relatively frequent occurrence of spontaneous calcareous embolization from an ulcerated calcified mitral annulus fibrosus in older adults.