Author + information
- Received June 30, 2015
- Revision received August 22, 2015
- Accepted August 25, 2015
- Published online October 27, 2015.
- Yigal Abramowitz, MD∗,
- Hasan Jilaihawi, MD∗,
- Tarun Chakravarty, MD∗,
- Michael J. Mack, MD† and
- Raj R. Makkar, MD∗∗ ()
- ∗Cedars-Sinai Heart Institute, Los Angeles, California
- †Department of Cardiovascular Surgery, Heart Hospital Baylor Plano, Baylor Health Care System, Plano, Texas
- ↵∗Reprint requests and correspondence:
Dr. Raj R. Makkar, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, AHSP, Suite A3600, Los Angeles, California 90048.
Mitral annulus calcification (MAC) is a chronic, degenerative process in the fibrous base of the mitral valve. Although MAC was initially thought to be an age-related degenerative process, there is accumulating evidence that other mechanisms, such as atherosclerosis and abnormal calcium-phosphorus metabolism, also contribute to the development of MAC. Despite its frequency, the clinical relevance of MAC is grossly underappreciated. Indeed, MAC is associated with an increased incidence of cardiovascular disease, mitral valve disease, arrhythmias, and mortality. MAC also influences the outcomes of cardiac surgery and interventions, and its clinical relevance may well increase substantially in the forthcoming era of transcatheter mitral valve replacement. In this paper, we review the available published data to provide a consistent, clinically relevant description of MAC on the basis of contemporary imaging. We describe the pathophysiological mechanisms contributing to the formation of MAC and the clinical implications of this disease entity.
Dr. Jilaihawi is a consultant for Edwards Lifesciences Corporation, St. Jude Medical, and Venus MedTech. Dr. Mack is a member of the executive committee of the PARTNER trial of Edwards Lifesciences Corporation but is uncompensated; and is coprincipal investigator of the COAPT Trial of Abbott Vascular. Dr. Makkar has received grant support from Edwards Lifesciences Corporation and St. Jude Medical; is a consultant for Abbott Vascular, Cordis, and Medtronic; and holds equity in Entourage Medical. Drs. Abramowitz and Chakravarty have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 30, 2015.
- Revision received August 22, 2015.
- Accepted August 25, 2015.
- American College of Cardiology Foundation