Arq Bras Cardiol: Imagem cardiovasc. 2022; 35(1): ecom19

My Approach to the Echocardiographic Assessment of Mitral Annular Calcification: Challenges and Particularities

DOI: 10.47593/2675-312X/20223501ecom19

Introduction

Mitral annular calcification (MAC) is a chronic degenerative process that affects the fibrous structure supporting the mitral valve. It is present in 8–15% of the general population; however, its prevalence can reach 40% in older people and 50% in patients with chronic kidney disease. Although it was previously classified as a degenerative pathophysiology associated with age or calcium metabolism, other etiological factors have been suggested, such as atherosclerotic disease and its risk factors (hypertension, obesity, dyslipidemia, diabetes mellitus, smoking), exposure to radiation therapy, and conditions that increase mitral valve stress, such as aortic valve stenosis, hypertrophic cardiomyopathy, and mitral valve prolapse. ^–

MAC is related to an increased risk of a number of adverse cardiac events, such as acute myocardial infarction, stroke, arrhythmias (conduction disorders and atrial fibrillation), and mitral valve disease (mitral stenosis, mitral regurgitation, and infective endocarditis). ^– It is also associated with a higher risk of complications and mortality in patients undergoing mitral valve surgery. Although most cases are not associated with mitral valve dysfunction, some may progress with an increased mitral transvalvular gradient. ^,

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