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Related Concept Videos

Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Mitral Regurgitation III: Medical Management01:25

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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

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Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
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Mitral Stenosis I: Introduction01:22

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Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
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Mitral Valve Prolapse II: Assessment and Management01:22

Mitral Valve Prolapse II: Assessment and Management

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IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular...
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Mitral Stenosis IV: Nursing Management01:27

Mitral Stenosis IV: Nursing Management

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A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...
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Transcatheter mitral valve options for severe mitral annular calcification.

Takayuki Onishi1, Ahmed El-Eshmawi2, Stamatios Lerakis1

  • 1Mount Sinai Fuster Heart Hospital, New York, NY, USA.

Annals of Cardiothoracic Surgery
|December 12, 2025
PubMed
Summary

Transcatheter mitral valve intervention (TMVI) offers an alternative for high-risk patients with mitral annular calcification (MAC)-associated disease. Despite challenges like anatomical complexities and device fixation, evolving techniques and devices are improving outcomes in valve-in-MAC procedures.

Keywords:
Mitral annular calcification (MAC)left ventricular outflow tract obstruction (LVOT obstruction)transcatheter edge-to-edge repair (TEER)transcatheter mitral valve replacement (TMVR)

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Mitral annular calcification (MAC)-associated mitral valve disease often affects high-risk patients unsuitable for surgery.
  • Transcatheter mitral valve intervention (TMVI) is a developing alternative, but MAC presents unique anatomical challenges.
  • Both transcatheter edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR) face specific hurdles due to MAC.

Purpose of the Study:

  • To review the challenges and advancements in TMVI for MAC-associated mitral valve disease.
  • To explore current and emerging transcatheter mitral valve replacement (TMVR) devices and techniques.
  • To discuss strategies for mitigating procedural risks and improving outcomes in valve-in-MAC (ViMAC) procedures.

Main Methods:

  • Review of existing literature on transcatheter mitral valve intervention (TMVI) in the context of mitral annular calcification (MAC).
  • Analysis of anatomical challenges posed by MAC for transcatheter edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR).
  • Evaluation of current and investigational TMVR devices (e.g., Tendyne, Intrepid, AltaValve, Cephea) and delivery approaches (transapical, transfemoral, transseptal, hybrid).
  • Discussion of adjunctive techniques (e.g., LAMPOON, BATMAN) to address left ventricular outflow tract (LVOT) obstruction.

Main Results:

  • Transcatheter edge-to-edge repair (TEER) success is limited by leaflet quality and reduced valve area in MAC.
  • Transcatheter mitral valve replacement (TMVR) faces hurdles including annular morphology, insufficient calcification for anchoring, and risk of left ventricular outflow tract (LVOT) obstruction.
  • Early valve-in-MAC (ViMAC) procedures had high mortality, but shifts towards transfemoral transseptal access and hybrid approaches show improved outcomes.
  • Newer systems and techniques are under investigation, but mid-term mortality for ViMAC TMVR remains a concern.

Conclusions:

  • Transcatheter mitral valve intervention (TMVI) is a promising but challenging option for mitral annular calcification (MAC)-associated mitral valve disease.
  • Advancements in device design, delivery systems, and adjunctive techniques are crucial for overcoming MAC-related anatomical complexities.
  • Continued innovation and careful patient selection are necessary to establish TMVI as a safe and effective treatment for this complex patient population.