Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications

Area of Science:

• Cardiology
• Biomedical Engineering
• Pathophysiology

Background:

• Mitral annular calcification (MAC) is a multifactorial disease with similarities to atherosclerosis, involving lipid accumulation and calcium deposition.
• MAC serves as a significant risk marker for cardiovascular events, including sudden death, and its progression negatively impacts patient quality of life.

Purpose of the Study:

• To review the pathophysiology of mitral annular calcification (MAC).
• To discuss recent findings and current diagnostic and treatment strategies for MAC.

Main Methods:

• Review of current literature on MAC pathophysiology, diagnosis, and treatment.
• Analysis of factors contributing to MAC development, such as shear stress, inflammation, and mineral metabolism dysregulation.
• Evaluation of surgical and transcatheter interventions for MAC.

Main Results:

• MAC development is influenced by shear stress, local inflammation, and mineral metabolism dysregulation.
• Surgical interventions for MAC present technical challenges, including risks of paravalvular leak (PVL) and atrioventricular groove disruption.
• Transcatheter mitral valve replacement shows promise for high-risk surgical candidates with severe MAC.

Conclusions:

• Effective management of MAC requires understanding its complex pathophysiology and associated risks.
• Surgical techniques like decalcification and reconstruction offer options but carry risks.
• Transcatheter mitral valve replacement represents a viable and promising therapeutic avenue for severe MAC in high-risk individuals.