Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations

  • Philippe B. Bertrand
  • Christos G. Mihos
  • Evin YucelEmail author
Valvular Heart Disease (J Dal-Bianco, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Valvular Heart Disease


Purpose of review

Mitral annular calcification (MAC) and associated calcific mitral stenosis (MS) are frequent in the aging population, although optimal management remains debated and outcomes are poor. This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options.

Recent findings

Surgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools has proven to be essential.


MAC and calcific MS is an increasingly prevalent, challenging issue with poor outcomes. While surgical valve replacement can be performed in patients with acceptable surgical risk, TMVR can be considered for patients at higher risk. Clinical trials are underway to optimize outcomes. Dedicated device designs and techniques to minimize risk of left ventricular outflow tract obstruction, paravalvular leakage, and device embolization are to be awaited.


Mitral annular calcification Calcific mitral stenosis Degenerative mitral stenosis TMVR Mitral valve surgery Mitral valve replacement 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts 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.

References and Recommended Reading

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

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Philippe B. Bertrand
    • 1
  • Christos G. Mihos
    • 2
  • Evin Yucel
    • 1
    Email author
  1. 1.Cardiac Ultrasound Laboratory, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Echocardiography LaboratoryColumbia University Division of Cardiology, Mount Sinai Heart InstituteMiami BeachUSA

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