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Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations

  • Valvular Heart Disease (J Dal-Bianco, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Mitral annular calcification (MAC) and associated calcific mitral stenosis (MS) are frequent in the aging population, although optimal management remains debated and outcomes are poor. This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options.

Recent findings

Surgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools has proven to be essential.

Summary

MAC and calcific MS is an increasingly prevalent, challenging issue with poor outcomes. While surgical valve replacement can be performed in patients with acceptable surgical risk, TMVR can be considered for patients at higher risk. Clinical trials are underway to optimize outcomes. Dedicated device designs and techniques to minimize risk of left ventricular outflow tract obstruction, paravalvular leakage, and device embolization are to be awaited.

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Authors and Affiliations

  1. Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA

    Philippe B. Bertrand MD, PhD & Evin Yucel MD

  2. Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA

    Christos G. Mihos DO

Authors
  1. Philippe B. Bertrand MD, PhD
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  2. Christos G. Mihos DO
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  3. Evin Yucel MD
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Correspondence to Evin Yucel MD.

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This article is part of the Topical Collection on Valvular Heart Disease

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Bertrand, P.B., Mihos, C.G. & Yucel, E. Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations. Curr Treat Options Cardio Med 21, 19 (2019). https://doi.org/10.1007/s11936-019-0723-6

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  • DOI: https://doi.org/10.1007/s11936-019-0723-6

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