Mitral Valve Dysfunction in Patients With Annular Calcification

Mitral annular calcification (MAC) is a common clinical finding and is associated with adverse clinical outcomes, but the clinical impact of MAC-related mitral valve (MV) dysfunction remains underappreciated. Patients with MAC frequently have stenotic, regurgitant, or mixed valvular disease, and this valvular dysfunction is increasingly recognized to be independently associated with worse prognosis. MAC-related MV dysfunction is a distinct pathophysiologic entity, and importantly much of the diagnostic and therapeutic paradigm from published rheumatic MV disease research cannot be applied in this context, leaving important gaps in our knowledge. This review summarizes the current epidemiology, pathophysiology, diagnosis, and classification of MAC-related MV dysfunction and proposes both an integrative definition and an overarching approach to this important and increasingly recognized clinical condition. [Display omitted] •MAC is increasingly prevalent in the elderly and associated with adverse outcomes.•Percutaneous transcatheter mitral valve replacement (valve-in-MAC) is a promising intervention, but outcome benefit has not been established.•Prospective studies are needed to establish criteria for assessment of MAC severity and clinical risk stratification, clarify indications for intervention, and compare management strategies.