Skip to main content

Advertisement

SpringerLink
Log in

Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications

  • Evidence-Based Medicine, Clinical Trials and Their Interpretations (L. Roever, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Yater WM, Cornell VH. The heart block due to calcareous lesions in the bundle of His. Ann Intern Med. 1935;8:777. https://doi.org/10.7326/0003-4819-8-7-777.

    Article  Google Scholar 

  2. Bedeir K, Kaneko T, Aranki S. Current and evolving strategies in the management of severe mitral annular calcification. The Journal of Thoracic and Cardiovascular Surgery 2018 volume 157, number 2. DOI: https://doi.org/10.1016/j.jtcvs.2018.05.099.

  3. Carpentier AF, Pellerin M, Fuzellier JF, Relland JY. Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg. 1996;111(4):718–30. https://doi.org/10.1016/S0022-5223(96)70332-X.

    Article  CAS  PubMed  Google Scholar 

  4. Roberts WC, Perloff JK. Mitral valvular disease: a clinicopathologic survey of the conditions causing the mitral valve to function abnormally. Ann Intern Med. 1972;77(939–975):939–75. https://doi.org/10.7326/0003-4819-77-6-939.

    Article  CAS  PubMed  Google Scholar 

  5. Nestico PF, Depace NL, Morganroth J, Kotler MN, Ross J. Mitral annular calcification: clinical, pathophysiology, and echocardiographic review. Am Heart J. 1984;107:989–96. https://doi.org/10.1016/0002-8703(84)90840-8.

    Article  CAS  PubMed  Google Scholar 

  6. Fox CS, Guo CY, Larson MG, Vasan RS, Parise H, O'Donnell CJ, et al. Relations of inflammation and novel risk factors to valvular calcification. Am J Cardiol. 2006;97:1502–5. https://doi.org/10.1016/j.amjcard.2005.11.086.

    Article  PubMed  Google Scholar 

  7. Maher ER, Young G, Smyth-Walsh B, Pugh S, Curtis JR. Aortic and mitral valve calcification in patients with end-stage renal disease. Lancet. 1987;2:875–7. https://doi.org/10.1016/s0140-6736(87)91370-5.

    Article  CAS  PubMed  Google Scholar 

  8. Abd Alamir M, Radulescu V, Goyfman M, et al. Prevalence and correlates of mitral annular calcification in adults with chronic kidney disease: results from CRIC study, 117e122. Atherosclerosis, DOI. 2015;242. https://doi.org/10.1016/j.atherosclerosis.2015.07.013.

  9. • Bortnick AE, Bartz TM, Ix JH, et al. Association of inflammatory, lipid and mineral markers with cardiac calcification in older adults. Heart. 2016;102:1826–34. https://doi.org/10.1136/heartjnl-2016-309404 It shows the association between fetuin-A and FGF-23 in MAC development.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Roberts WC. The senile cardiac calcification syndrome. Am J Cardiol. 1986;58:572–4. https://doi.org/10.1016/0002-9149(86)90045-7.

    Article  CAS  PubMed  Google Scholar 

  11. Adler Y, Fink N, Spector D, Wiser I, Sagie A. Mitral annulus calcification - a window to diffuse atherosclerosis of the vascular system. Atherosclerosis. March 2001;155(1):1–8. https://doi.org/10.1016/s0021-9150(00)00737-1.

    Article  CAS  PubMed  Google Scholar 

  12. Sharma R, Pellerin D, Gaze DC, Mehta RL, Gregson H, Streather CP, et al. Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease. Atherosclerosis. 2007;191:348–54. https://doi.org/10.1016/j.atherosclerosis.2006.03.033.

    Article  CAS  PubMed  Google Scholar 

  13. O’Neal WT, Efird JT, Nazarian S, et al. Mitral annular calcification progression and the risk of atrial fibrillation: results from MESA. European Heart Journal - Cardiovascular Imaging (2017) 0, 1–6. DOI: https://doi.org/10.1093/ehjci/jex093.

  14. Benjamin EJ, Plehn JF, D’Agostino RB, Belanger AJ, Comai K, Fuller DL, et al. Mitral annular calcification and the risk of stroke in an elderly cohort. N Engl J Med. 1992;327:374–9. https://doi.org/10.1056/NEJM199208063270602.

    Article  CAS  PubMed  Google Scholar 

  15. • Dietl C, Hawthorn C, Raizada V. Risk of cerebral embolization with caseous calcification of the mitral annulus: review article. The Open Cardiovascular Medicine Journal. 2016;10(1):221–32. https://doi.org/10.2174/1874192401610010221 It alerts for the high risk of CVE in patients with CCMA.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Labovitz AJ, Nelson JG, Windhorst DM, Kennedy HL, Williams GA. Frequency of mitral valve dysfunction from mitral anular calcium as detected by Doppler echocardiography. Am J Cardiol. 1985;55:133–7. https://doi.org/10.1016/0002-9149(85)90314-5.

    Article  CAS  PubMed  Google Scholar 

  17. Simon MA, Liu SF. Calcification of the mitral valve annulus and its relation to functional valvular disturbance. Am Heart J. 1954;48:497–505. https://doi.org/10.1016/0002-8703(54)90116-7.

    Article  CAS  PubMed  Google Scholar 

  18. Lung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on valvular heart disease. Eur Heart J. 2003;24:1231–43. https://doi.org/10.1016/s0195-668x(03)00201-x.

    Article  Google Scholar 

  19. Freeman RV, Otto CM. Spectrum of calcific aortic valve disease: pathogenesis, disease progression, and treatment strategies. Circulation. 2005;111:3316–26. https://doi.org/10.1161/CIRCULATIONAHA.104.486738.

    Article  PubMed  Google Scholar 

  20. • Afshar M, Luk K, Do R, et al. Association of triglyceride-related genetic variants with mitral annular calcification. Am J Cardiol. 2017;69:24. https://doi.org/10.1016/j.jacc.2017.04.051 Genetic predisposition to high triglyceride levels might lead to MAC development.

    Article  CAS  Google Scholar 

  21. Shekar C, Budoff M. Calcification of the heart: mechanisms and therapeutic avenues. Expert Rev Cardiovasc Ther. 2018. https://doi.org/10.1080/14779072.2018.1484282.

  22. Zekry SB, Freeman J, Jajoo A, et al. Patient-specific quantitation of mitral valve strain by computer analysis of three-dimensional echocardiography a pilot study. Circ Cardiovasc Imaging. 2016;9:e003254. https://doi.org/10.1161/CIRCIMAGING.115.003254.

    Article  PubMed  Google Scholar 

  23. Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation. 2006;113:861–6. https://doi.org/10.1161/CIRCULATIONAHA.105.552844.

    Article  PubMed  Google Scholar 

  24. Johnson R, Leopold JA, Loscalzo J. Vascular calcification pathobiological mechanisms and clinical implications. Circ Res. 2006;99:1044–59. https://doi.org/10.1161/01.RES.0000249379.55535.21.

    Article  CAS  PubMed  Google Scholar 

  25. Albanese I, Khan K, Barratt B, et al. Atherosclerotic calcification: Wnt is the hint. J Am Heart Assoc. 2018;7:e007356. https://doi.org/10.1161/JAHA.117.007356.

    Article  PubMed  PubMed Central  Google Scholar 

  26. • Cetin EHO, Cetin MS, Canpolat U, et al. The forgotten variable of shear stress in mitral annular calcification: whole blood viscosity. Med Princ Pract. 2015;24:444–50. https://doi.org/10.1159/000431362 Shear stress as an important role in MAC physiopathology.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gomel MA, Lee RK, Grande-Allen KJ. Comparing the role of mechanical forces in vascular and valvular calcification progression. Front Cardiovasc Med. 2018;5:197. https://doi.org/10.3389/fcvm.2018.00197.

    Article  CAS  PubMed  Google Scholar 

  28. Pagnozzi LA, Butcher JT. Mechanotransduction mechanisms in mitral valve physiology and disease pathogenesis. Front Cardiovasc Med. 2017;4:83. https://doi.org/10.3389/fcvm.2017.00083.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Wylie-Sears J, Aikawa A, Levine RA, et al. Mitral valve endothelial cells with osteogenic differentiation potential. Arterioscler Thromb Vasc Biol. 2011;31:598–607. https://doi.org/10.1161/ATVBAHA.110.216184.

    Article  CAS  PubMed  Google Scholar 

  30. Schoen FJ. Evolving concepts of cardiac valve dynamics. Circulation. 2008;118(18):1864–80. https://doi.org/10.1161/CIRCULATIONAHA.108.805911.

    Article  PubMed  Google Scholar 

  31. Rezaeian P, Miller PE, Haberlen SA, Razipour A, Bahrami H, Castillo R, et al. Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: multicenter AIDS cohort study. J Cardiovasc Comput Tomogr. 2016;10(3):229–36. https://doi.org/10.1016/j.jcct.2016.02.002.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Guler S, Varol E. The relation between echocardiographic epicardial fat thickness and mitral annular calcification. Afri Health Sci. 2019;19(1):1657–64. https://doi.org/10.4314/ahs.v19i1.41.

    Article  Google Scholar 

  33. Holmberg SD, Moorman AC, Williamson JM, Tong TC, Ward DJ, Wood KC, et al. Protease inhibitors and cardiovascular outcomes in patients with HIV-1. Lancet. 2002;360:1747–8. https://doi.org/10.1016/S0140-6736(02)11672-2.

    Article  CAS  PubMed  Google Scholar 

  34. Tibuakuu M, Zhao D, Boer IH, et al. Relation of serum vitamin D to risk of mitral annular and aortic valve calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol. 2017 August 01;120(3):473–8. https://doi.org/10.1016/j.amjcard.2017.05.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Silva AP, Gundlach K, Büchel J, et al. Low magnesium levels and FGF-23 dysregulation predict mitral valve calcification as well as intima media thickness in predialysis diabetic patients. International Journal of Endocrinology. 2015;308190:10. https://doi.org/10.1155/2015/308190.

    Article  CAS  Google Scholar 

  36. Montezano AC, Zimmerman D, Yusuf H, Burger D, Chignalia AZ, Wadhera V, et al. Vascular smooth muscle cell differentiation to an osteogenic phenotype involves TRPM7 modulation by magnesium. Hypertension. 2010;56:453–62. https://doi.org/10.1161/HYPERTENSIONAHA.110.152058.

    Article  CAS  PubMed  Google Scholar 

  37. Thanassoulis G, Campbell CY, Owens DS, Smith JG, Smith AV, Peloso GM, et al. Genetic associations with valvular calcification and aortic stenosis. N Engl J Med. 2013;368:503–12. https://doi.org/10.1056/NEJMoa1109034.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Fox CS, Vasan RS, Parise H, Levy D, O'Donnell CJ, D'Agostino RB, et al. Mitral annular calcification predicts cardiovascular morbidity and mortality. Circulation. 2003;107:1492–6. https://doi.org/10.1161/01.cir.0000058168.26163.bc.

    Article  PubMed  Google Scholar 

  39. Movva R, Murthy K, Romero-Corral A, Seetha Rammohan HR, Fumo P, Pressman GS. Calcification of the mitral valve and annulus: systematic evaluation of effects on valve anatomy and function. J Am Soc Echocardiogr. 2013;26(10):1135–42. https://doi.org/10.1016/j.echo.2013.06.014.

    Article  PubMed  Google Scholar 

  40. Iwataki M, Takeuchi M, Otani K, Kuwaki H, Yoshitani H, Abe H, et al. Calcific extension towards the mitral valve causes non-rheumatic mitral stenosis in degenerative aortic stenosis: real-time 3D transoesophageal echocardiography study. Open Heart. 2014;1:e000136. https://doi.org/10.1136/openhrt-2014-000136.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yeboah J, Carr JJ, Terry JG, Ding J, Zeb I, Liu S, et al. Computed tomography-derived cardiovascular risk markers, incident cardiovascular events, and all-cause mortality in non-diabetics. The Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol. 2014 October;21(10):1233–41. https://doi.org/10.1177/2047487313492065.

    Article  PubMed  Google Scholar 

  42. Higgins J, Mayo J, Skarsgard P. Cardiac computed tomography facilitates operative planning in patients with mitral calcification. Ann Thorac Surg. 2013;95:e9–11. https://doi.org/10.1016/j.athoracsur.2012.07.059.

    Article  PubMed  Google Scholar 

  43. • Blanke P, Naoum C, Dvir D, et al. Predicting LVOT obstruction in Transcatheter mitral valve implantation concept of the neo-LVOT. JACC Cardiovasc Imaging. 2017;10(4):482–5. https://doi.org/10.1016/j.jcmg.2016.01.005 The concept of simulating a new LVOT to predict obstruction after TMVR.

    Article  PubMed  Google Scholar 

  44. Kurazumi H, Mikamo A, Suzuki R, Hamano K. Mitral-valve replacement for a severely calcified mitral annulus: a simple and novel technique. Eur J Cardiothorac Surg. 2011 Mar;39(3):407–9. https://doi.org/10.1016/j.ejcts.2010.06.017.

    Article  PubMed  Google Scholar 

  45. Kohsaka S, Jin Z, Rundek T, et al. Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the northern Manhattan study. J Am Coll Cardiol Img. 2008;1:617–23. https://doi.org/10.1016/j.jcmg.2008.07.006.

    Article  Google Scholar 

  46. •• Eleid MF, Foley TA, Said SM, Pislaru SV, Rihal CS. Severe mitral annular calcification: multimodality imaging for therapeutic strategies and interventions. JACC Cardiovasc Imaging. 2016;9:1318–37. https://doi.org/10.1016/j.jcmg.2016.09.001 Imaging assessment, classification and importance to interventions in MAC.

    Article  PubMed  Google Scholar 

  47. Deluca G, Correale M, Ieva R, del Salvatore B, Gramenzi S, di Biase M. The incidence and clinical course of caseous calcification of the mitral annulus: a prospective echocardiographic study. J Am Soc Echocardiogr. 2008;21:828–33. https://doi.org/10.1016/j.echo.2007.12.004.

    Article  PubMed  Google Scholar 

  48. Curl E, Riemer E. Caseous calcification of the mitral annulus: case report and brief review. European Heart Journal - Case Reports. 2018;2(4). https://doi.org/10.1093/ehjcr/yty124.

  49. Harpaz D, Auerbach I, Vered Z, et al. Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. J Am Soc Echocardiogr. 2001;14:825–31. https://doi.org/10.1067/mje.2001.111877.

    Article  CAS  PubMed  Google Scholar 

  50. Mazzucco A, Abbasciano R, Onorati F, Brognoli G, Fanti D, Gottin L. Anterior mitral annulus caseoma: as benign as posterior counterparts? Cardiovasc Pathol. 2016;25:336–8. https://doi.org/10.1016/j.carpath.2015.10.002.

    Article  PubMed  Google Scholar 

  51. Dingli P, Felice H, Mizzi A, Montefort S. Caseous mitral annular calcification mimicking a lung tumor on chest X-ray. J Family Med Prim Care. 2017;6:442–4. https://doi.org/10.4103/jfmpc.jfmpc_416_16.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ono M, Mizuno A, Masuda K, Suzuki K, Abe K, Kawazoe K, et al. Infective endocarditis on caseous calcification of the mitral annulus involving both the anterior and posterior annulus: a rare case report. Intern Med. 2018 Apr 1;57(7):965–9. https://doi.org/10.2169/internalmedicine.9520-17.

    Article  PubMed  Google Scholar 

  53. Michałowska I, Szymański P, Kwiatek P, Spałek M, Furmanek M, Zieliński P, et al. Caseous calcification of the mitral annulus – the complementary role of computed tomography and transthoracic echocardiogram. Pol J Radiol. 2018;83:537–42. https://doi.org/10.5114/pjr.2018.81148.

    Article  Google Scholar 

  54. Konety SH, Koene RJ, Norby FL, et al. Echocardiographic predictors of sudden cardiac death the Atherosclerosis Risk in Communities Study and Cardiovascular Health Study. Circ Cardiovasc Imaging. 2016;9:e004431. https://doi.org/10.1161/CIRCIMAGING.115.004431.

    Article  PubMed  Google Scholar 

  55. Matsuyama TA, Ishibashi-Ueda H, Ikeda Y, Nagatsuka K, Miyashita K, Amaki M, et al. Critical multi-organ emboli originating from collapsed, vulnerable caseous mitral annular calcification. Pathol Int. 2012;62(7):496–9. https://doi.org/10.1111/j.1440-1827.2012.02826.x.

    Article  PubMed  Google Scholar 

  56. Sequeira A, Morris L, Patel B, et al. Calcific mitral stenosis in the hemodialysis patient. Hemodial Int. 2014;18(1):212–4. https://doi.org/10.1111/hdi.12094.

    Article  PubMed  Google Scholar 

  57. Labovitz AJ, Nelson JG, Windhorst DM, Kennedy HL, Williams GA. Frequency of mitral valve dysfunction from mitral anular calcium as detected by Doppler echocardiography. Am J Cardiol. 1985;55:133–7. https://doi.org/10.1016/0002-9149(85)90314-5.

    Article  CAS  PubMed  Google Scholar 

  58. Fulkerson PK, Beaver BM, Auseon JC, Graber HL. Calcification of the mitral annulus: etiology, clinical associations, complications and therapy. Am J Med. 1979;66(6):967–77. https://doi.org/10.1016/0002-9343(79)90452-2.

    Article  CAS  PubMed  Google Scholar 

  59. Hospital TG, Hospital M. Bacterial endocarditis of the mitral valve associated with annular calcification 119: 323–326, 1978.

  60. Minardi G, Pino PG, Sordi M, Pavaci H, Manzara C, Pulignano G, et al. Infective endocarditis on mitral annular calcification: a case report. Cases Journal. 2009;2:9072. https://doi.org/10.1186/1757-1626-2-9072.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Eicher JC, De Nadai L, Soto FX, et al. Bacterial endocarditis complicating mitral annular calcification: a clinical and echocardiographic study. J Heart Valve Dis. 2004;13:217–27.

    PubMed  Google Scholar 

  62. Vistarini N, d’Alessandro C, Aubert S, et al. Surgery for infective endocarditis on mitral annulus calcification. J Heart Valve Dis. 2007;16:611–6.

    PubMed  Google Scholar 

  63. Nair CK, Runco V, Everson GT, Boghairi A, Mooss AN, Mohiuddin SM, et al. Conduction defects and mitral annulus calcification. Br Heart J. 1980;44:162–7. https://doi.org/10.1136/hrt.44.2.162.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. O’Neal WT, Efird JT, Nazarian S, et al. Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis. Europace. 2015;17:358–63. https://doi.org/10.1093/europace/euu265.

    Article  PubMed  Google Scholar 

  65. Pekdemir H, Cansel M, Yagmur J, et al. Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification. J Electrocardiol. 2010;43:339–43. https://doi.org/10.1016/j.jelectrocard.2010.02.013.

    Article  PubMed  Google Scholar 

  66. • Saran N, Greason KL, Schaff HV, et al. Does mitral valve calcium in patients undergoing mitral valve replacement portend worse survival? Ann Thorac Surg 2018. 2019;107(2):444–52. https://doi.org/10.1016/j.athoracsur.2018.07.098 A less aggressive surgery achieves satisfactory results in treating MAC.

    Article  Google Scholar 

  67. Price J, Glineur D, De Kerchove L, El Khoury G. Mitral valve repair is feasible following extensive decalcification and reconstruction of the atrioventricular groove. J Heart Valve Dis. 2015 Jan;24(1):46–52.

    PubMed  Google Scholar 

  68. Kurazumi H, Mikamo A, Suzuki R, Hamano K. Mitral valve replacement in patients with severely calcified mitral valve annulus: surgical technique. Eur J Cardiothorac Surg. 2011;39(3):407–9. https://doi.org/10.1016/j.ejcts.2010.06.017.

    Article  PubMed  Google Scholar 

  69. David TE, Feindel CM, Armstrong S, Sun Z. Reconstruction of the mitral anulus: a ten-year experience. J Thorac Cardiovasc Surg. 1995;110(5):1323–32. https://doi.org/10.1016/S0022-5223(95)70055-2.

    Article  CAS  PubMed  Google Scholar 

  70. Atoui R, Lash V, Mohammadi S, et al. Intra-atrial implantation of a mitral valve prosthesis in a heavily calcified mitral annulus. Eur J Cardiothorac Surg. 2009;36:776–8. https://doi.org/10.1016/j.ejcts.2009.05.035.

    Article  PubMed  Google Scholar 

  71. Cammack PL, Edie RN, Edmunds LH Jr. Bar calcification of the mitral annulus. A risk factor in mitral valve replacement. J Thorac Cardiovasc Surg. 1987;94:399–404.

    Article  CAS  Google Scholar 

  72. Nataf P, Pavie A, Jault F, et al. Intraatrial insertion of a mitral prosthesis in a destroyed or calcified mitral annulus. Ann Thorac Surg. 1994;58:163–7. https://doi.org/10.1016/0003-4975(94)91092-8.

    Article  CAS  PubMed  Google Scholar 

  73. Coselli JS, Crawford ES. Calcified mitral valve annulus: prosthesis insertion. Ann Thorac Surg. 1988;46:584–6. https://doi.org/10.1016/s0003-4975(10)64709-1.

    Article  CAS  PubMed  Google Scholar 

  74. Stefano SD, Lopez J, Florez S, et al. Building a new annulus: a technique for mitral valve replacement in heavily calcified annulus. Ann Thorac Surg. 2009;87:1625–7. https://doi.org/10.1016/j.athoracsur.2008.09.014.

    Article  PubMed  Google Scholar 

  75. MPBO S, LRP C, Rayol SC, RGS D, Menezes AM, Clavel MA, et al. Prothesis-patient mismatch negatively affects outcomes after mitral valve replacement: meta-analysis of 10.239 patients. Braz J Cardiovasc Surg. 2019;34(2):203–12. https://doi.org/10.21470/1678-9741-2019-0069.

    Article  Google Scholar 

  76. Lafrenière-Bessi V, Cameron-Gagné M, Perron J, Lévesque MH, Laflamme M, Charbonneau É, et al. Mitral annular calcification and mitral valve replacement: a new approach. Ann Thorac Surg. 2018 Feb;105(2):e55–7. https://doi.org/10.1016/j.athoracsur.2017.09.028.

    Article  PubMed  Google Scholar 

  77. Chauvette V, Laflamme É, Lafrenière-Bessi V, Marzouk M, Bertrand O, O'Connor K, et al. Caseous calcification of the mitral annulus: a role for surgery. Ann Thorac Surg. 2019;S0003-4975(19)31566–8. https://doi.org/10.1016/j.athoracsur.2019.08.110.

  78. •• Guerrero M, Urena M, Himbert D, Wang DD, et al. 1-Year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Am Coll Cardiol. 2018;71:1841–53. https://doi.org/10.1016/j.jacc.2018.02.054 A promise for future treatment of severe MAC.

    Article  PubMed  Google Scholar 

  79. Praz F, Khalique OK, Lee R, Veeragandham R, Russell H, Guerrero M, et al. Transatrial implantation of a transcatheter heart valve for severe mitral annular calcification. J Thorac Cardiovasc Surg. 2018. https://doi.org/10.1016/j.jtcvs.2018.03.016.

  80. Russell HM, Guerrero ME, Salinger MH, et al. Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification. J Am Coll Cardiol. 2018;72:1437–48. https://doi.org/10.1016/j.jacc.2018.07.033.

    Article  PubMed  Google Scholar 

  81. Pala AA, Iner H, Ercisli MA. Approach to an unusual cardiac mass: mitral annulus caseoma. Braz J Cardiovasc Surg. 2019. https://doi.org/10.21470/1678-9741-2018-0361 Creative Commons user license https://creativecommons.org/licenses/by/4.0/.

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil

    Luiz Rafael P. Cavalcanti, Michel Pompeu B. O. Sá, Álvaro M. Perazzo, Antonio C. Escorel Neto, Rafael A. F. Gomes & Ricardo C. Lima

  2. University of Pernambuco – UPE, Recife, Brazil

    Luiz Rafael P. Cavalcanti, Michel Pompeu B. O. Sá, Álvaro M. Perazzo, Antonio C. Escorel Neto, Rafael A. F. Gomes & Ricardo C. Lima

  3. Recife, Brazil

    Luiz Rafael P. Cavalcanti

  4. Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute – FCM/ICB, Recife, Brazil

    Michel Pompeu B. O. Sá & Rafael A. F. Gomes

  5. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany

    Alexander Weymann, Konstantin Zhigalov & Arjang Ruhparwar

Authors
  1. Luiz Rafael P. Cavalcanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Pompeu B. O. Sá
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Álvaro M. Perazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio C. Escorel Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rafael A. F. Gomes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander Weymann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Konstantin Zhigalov
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Arjang Ruhparwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ricardo C. Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Conflict of Interest

Luiz Rafael P. Cavalcanti, Michel Pompeu B. O. Sá, Álvaro M. Perazzo, Antonio C. Escorel Neto, Rafael A. F. Gomes, Alexander Weymann, Konstantin Zhigalov, Arjang Ruhparwar, and Ricardo C. Lima each declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Evidence-Based Medicine, Clinical Trials and Their Interpretations

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cavalcanti, L.R.P., Sá, M.P.B.O., Perazzo, Á.M. et al. Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications. Curr Atheroscler Rep 22, 9 (2020). https://doi.org/10.1007/s11883-020-0825-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-020-0825-3

Keywords

Search

Navigation