Mitral annular calcification: challenges and future perspectives

Abstract

Mitral annular calcification (MAC) is a chronic degenerative process that implies calcification on the mitral support structure. It usually appears as a bystander to other cardiac pathologies hindering surgical treatment and increasing morbidity and mortality. When addressing the mitral valve, many surgical strategies have been suggested in the past with no clear consensus on what to choose. Moreover, and as transcatheter therapies have gained popularity over the last few decades, transcatheter mitral valve implantation has appeared as another alternative to conventional surgery. In this review, we aim at describing an overview of MAC, highlighting current challenges and treatment options as well as new potential alternatives.

Keywords: Mitral annular calcification; Mitral valve; Transcatheter.

Fig. 1

Computed tomographic scan showing a heavily calcified mitral annulus

Fig. 2

Transthoracic echocardiogram (short axis) showing posterior mitral annular calcification

Fig. 3

Intraoperative image of a balloon-expandable transcatheter mitral valve replacement

Fig. 4

Preprocedural computed tomographic planning

Fig. 5

Preprocedural computed tomographic planning with a virtual valve in mitral position

Fig. 6

Preprocedural 3D reconstruction with a virtual valve in mitral position and the neo-left ventricular outflow tract

Fig. 7

Preprocedural computed tomographic reconstruction with a virtual valve in mitral position and the neo-left ventricular outflow tract area

Fig. 8

Surgical view over the mitral valve. a The arrow points to the calcified annulus. b After decalcification and valve excision, the arrow points to the posterior annulus where the decalcification has been performed. c Mitral valve after reinforcing the posterior annulus with a glutaraldehyde-preserved bovine pericardial patch, the arrow points to the patch. d After mitral valve replacement, the arrow points to the prosthesis