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Thrombus on Mitral Annular Calcification: A Systematic Review of Management and Outcomes

Amber Cintosun1, David Belzile2, Maala Sooriyakanthan2

  • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

CJC Open
|December 30, 2024
PubMed
Abstract

Insights

Thrombus formation on mitral annular calcification (MAC) is rare but increases thromboembolic risk. Most patients with MAC thrombus are managed with anticoagulation, though some require surgery, and persistent thrombus or embolization can occur.

Area of Science:

  • Cardiology
  • Valvular Heart Disease
  • Thrombosis

Background:

  • Mitral annular calcification (MAC) is a common degenerative process affecting the mitral valve.
  • Thrombus formation on MAC is a rare but significant complication, increasing the risk of thromboembolic events.
  • Current understanding of outcomes and management strategies for MAC thrombus is limited.

Purpose of the Study:

  • To conduct a systematic review describing the management and outcomes of patients with thrombus on MAC.
  • To identify treatment strategies and associated clinical events in this patient population.

Main Methods:

  • Systematic search of MEDLINE, Embase, and Cochrane databases.
  • Inclusion of studies reporting on patients with thrombus on MAC, excluding those with prior valve intervention or prosthesis.
  • Primary outcome assessment included treatment, mortality, and thromboembolic events.

Main Results:

  • The review included 15 studies with 22 cases; most patients were female and presented with stroke, transient ischemic event, or myocardial infarction.
  • The majority of patients (77%) were treated with anticoagulation alone; 23% required surgery, often for recurrent embolization.
  • No mortality was reported, but 27% experienced post-diagnosis thromboembolic events, and 23% on anticoagulation alone had persistent thrombus.

Conclusions:

  • Patients with MAC presenting with thromboembolic events require echocardiographic assessment for thrombus.
  • While anticoagulation is often sufficient, a notable proportion of patients necessitate surgical intervention.
  • Persistent thrombus and recurrent embolization are common, highlighting the need for further research into optimal long-term management.

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