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Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management

Bo Xu1, Duygu Kocyigit1, Tom Kai Ming Wang1

  • 1Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195, USA.

European Heart Journal. Cardiovascular Imaging
|September 30, 2021
PubMed

Insights

Mitral annular calcification (MAC) involves calcium in the mitral valve, linked to heart issues. This study reviews imaging and proposes a new classification system for MAC severity.

Area of Science:

  • Cardiology
  • Medical Imaging

Background:

  • Mitral annular calcification (MAC) is calcium deposition in the heart's mitral valve fibrous skeleton.
  • MAC is associated with mitral valve dysfunction, increased cardiovascular risk, arrhythmias, and endocarditis.

Purpose of the Study:

  • To review multimodality imaging for evaluating MAC and associated valvular dysfunction.
  • To propose a novel classification system for MAC severity.

Main Methods:

  • Review of echocardiography and cardiac computed tomography (CT) for MAC assessment.
  • Development of a classification system based on qualitative and quantitative imaging measurements.

Main Results:

  • Echocardiography is the primary tool for mitral valve assessment.
  • Cardiac CT is valuable for procedure planning and quantitative MAC grading.
  • A new classification system for MAC severity is proposed.

Conclusions:

  • Current MAC classification lacks universal acceptance.
  • A standardized, multimodality imaging-based classification system is needed.
  • The proposed system integrates echocardiography and CT for comprehensive MAC evaluation.

Keywords:
calcific mitral stenosiscalcium scoringcardiac computed tomographyechocardiographymitral annular calcificationmitral regurgitationmultimodality imagingtranscatheter mitral valve repairtranscatheter mitral valve replacement

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