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Mitral Valve Replacement for Mitral Stenosis Secondary to Massive Mitral Annular Calcium

Minseob Jeong1, William C Roberts2

  • 1Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.

The American Journal of Cardiology
|January 15, 2023
PubMed

Insights

Massive mitral annular calcium (MAC) can cause mitral stenosis (MS). Mitral valve replacement in these cases carries a high risk, with 6 of 11 patients dying postoperatively.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Mitral annular calcium (MAC) is a common finding in elderly populations.
  • Massive MAC can obstruct mitral valve inflow, leading to mitral stenosis (MS).
  • The surgical risks associated with mitral valve replacement (MVR) in massive MAC are not well-defined.

Purpose of the Study:

  • To highlight the potential hazards of mitral valve replacement in patients with mitral stenosis secondary to massive mitral annular calcium.
  • To describe the clinical outcomes and valve morphology in patients undergoing MVR for massive MAC.

Main Methods:

  • Retrospective review of clinical data and operative findings.
  • Analysis of 11 patients who underwent mitral valve replacement for mitral stenosis secondary to massive MAC.
  • Morphological assessment of excised mitral valves.

Main Results:

  • Six out of 11 patients (54.5%) died postoperatively.
  • Five of the deceased patients had severe (4+/4+) MAC.
  • Massive MAC was characterized by extensive calcification of the posterior mitral leaflet extending to the anterior leaflet.

Conclusions:

  • Mitral valve replacement in patients with mitral stenosis secondary to massive MAC is associated with high operative mortality.
  • Careful consideration and risk stratification are crucial before proceeding with MVR in these complex cases.
  • The extent of MAC, particularly severe calcification, is a significant predictor of poor outcomes.
Keywords:
Mitral annular calciumaortic stenosismitral valve replacementmitral valve stenosis

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