Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications

• Published in: Current atherosclerosis reports Vol. 22; no. 2; p. 9
• Main Authors: Cavalcanti, Luiz Rafael P., Sá, Michel Pompeu B. O., Perazzo, Álvaro M., Escorel Neto, Antonio C., Gomes, Rafael A. F., Weymann, Alexander, Zhigalov, Konstantin, Ruhparwar, Arjang, Lima, Ricardo C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 07.02.2020
• Subjects: Angiology; Cardiology; Clinical Trials and Their Interpretations; Clinical Trials and Their Interpretations (L. Roever; Evidence-Based Medicine; Medicine; Medicine & Public Health; Section Editor; Topical Collection on Evidence-Based Medicine; Mitral annular calcification; Transcatheter mitral valve replacement; Atherosclerosis; Mitral valve replacement
• ISSN: 1523-3804; 1534-6242
• DOI: 10.1007/s11883-020-0825-3

Purpose of Review This review summarizes the pathophysiology of mitral annular calcification (MAC) with recent findings and current strategies for diagnosis and treatment. Recent Findings Major factors in MAC development seem to be shear stress of the flow past the mitral valve, local inflammation, and dysregulation in regulators of mineral metabolism. MAC itself poses daunting technical challenges. Implanting a valve on top of the calcium bar might lead to paravalvular leak (PVL) that is less likely to heal. Annular decalcification allows for better valve seating and potentially better healing and less PVL. This, however, comes with the risk for catastrophic atrioventricular groove disruption. MAC can be sharply dissected with the scalpel; the annulus can be reconstructed with the autologous pericardium. Transcatheter mitral valve replacement is a promising approach in the treatment of patients who are deemed high-risk surgical candidates with severe MAC. Summary MAC is a multifactorial disease that has some commonalities with atherosclerosis, mainly regarding lipid accumulation and calcium deposition. It is of great clinical importance, being a risk marker of cardiovascular events (including sudden death) and, with its progression, can have a negative impact on patients’ lives.