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Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory

Mayra E Guerrero1, Paul Grayburn2, Robert L Smith2

  • 1Mayo Clinic, Rochester, Minnesota, USA.

JACC. Cardiovascular Interventions
|September 27, 2023
PubMed

Insights

Mitral annular calcium (MAC) with severe mitral valvular dysfunction poses challenges for valve replacement. This review categorizes MAC features to guide treatment decisions for surgical or transcatheter interventions.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Mitral annular calcium (MAC) complicates severe mitral valvular dysfunction.
  • Valve replacement (surgical or transcatheter) is technically challenging due to patient anatomy, comorbidities, and age.

Purpose of the Study:

  • To review clinical and anatomical features of MAC relevant to mitral valve interventions.
  • To develop recommendations and a grading system for treating MAC with severe mitral valvular dysfunction.

Main Methods:

  • Expert working group convened under the Heart Valve Collaboratory.
  • Review of clinical and anatomical features of MAC.
  • Development of a grading and staging system (green, yellow, red light).

Main Results:

  • Identification of favorable (green light), challenging (yellow light), and prohibitive (red light) features of MAC for interventions.
  • Proposed grading and staging system based on anatomical and clinical factors.

Conclusions:

  • A structured approach is needed to manage MAC with severe mitral valvular dysfunction.
  • The proposed system aims to guide treatment decisions for surgical or transcatheter mitral valve interventions.

Keywords:
mitral annulus calcificationmitral annulus calcification severity classificationmitral valve surgerytranscatheter mitral valve replacement

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