Mitral Annular Calcification (MAC)

Mitral annular calcification (MAC) is a degenerative process that affects the fibrous ring around the mitral valve and is thought to be caused by chronic inflammation, oxidative stress, and altered calcium metabolism. Although often asymptomatic, MAC can cause mitral valve stenosis and/or regurgitation with associated symptoms ranging from shortness of breath and fatigue to palpitations and stroke.

Diagnosis is often made with echocardiography, but MAC can also be seen with MRI and CT imaging. Medical therapies usually aim to manage mitral valvulopathies and associated conditions like hypertension and diabetes. Surgical intervention may be necessary in cases of severe mitral stenosis or regurgitation.

In the video, one can appreciate calcium deposits around the mitral valve annulus causing thickened, restricted anterior leaflet (ALMV) and posterior leaflet (PLMV) motion. Furthermore, a mobile plaque is visualized in the “en face” (left atrial perspective) view in the lateral region of the ALMV. In this example, MAC caused mild mitral stenosis and severe mitral regurgitation requiring mitral valve replacement.

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