Mitral annulus calcification is a degenerative process involving the mitral valve ring, that sometimes extends to the whole valvular apparatus. It has the same risk factors as atherosclerosis and is more often found in chronic kidney disease, radiation therapy, and elderly patients. This condition sometimes causes mitral stenosis and more often mitral regurgitation and is associated with atrial fibrillation, atrioventricular block, stroke and cardiovascular mortality, being a good indicator of global atherosclerotic burden.
Mitral annulus calcification is usually asymptomatic unless it is severe enough to impair forward blood flow or cause severe mitral regurgitation, leading to left atrial enlargement and atrial fibrillation  or is associated with significant degenerative disease of the aortic valve . Severe calcification may cause mitral stenosis  and is associated with multiple coronary artery disease with an unstable plaque and high myocardial infarction risk and increased likelihood of stroke . However, it is unclear whether the mitral calcification causes stroke by embolization or the cerebral disease is due to cerebrovascular atherosclerosis because patients with this mitral abnormality also have significant aortic and carotid plaque. Also, affected individuals develop endocarditis more often . Heart rhythm can also be impaired by mitral annulus calcification, that is associated with atrial fibrillation and conduction abnormalities: atrioventricular block and bundle branch block . Aortic valve calcification and stenosis may also be present, sometimes causing symptoms .
Entire Body System
- Heart Disease
Abstract M-mode and two-dimensional echocardiograms of 3,254 patients without evidence of rheumatic heart disease were evaluated retrospectively for evidence of aortic cusp calcification and mitral annulus calcification. [ncbi.nlm.nih.gov]
Valvular Heart Disease, EP Basic Science, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital [acc.org]
Posted in cardiology -Therapeutics, Cardiology -unresolved questions, cardiology women, Cardiology-Coronary artery disese, echocardiography, MVPS, valvular heart disease, tagged annular vt, mac, mitral annular calcifcation, mitral valve calcification [drsvenkatesan.com]
Clinical diagnosis included rheumatic heart disease (32%), noninflammatory calcific disease (34%), and chronic renal failure (32%). [archinte.jamanetwork.com]
Her past medical history was significant for osteoporosis and spine surgery. Initial physical examination revealed no abnormalities. Her heartbeat was regular, and no cardiac murmurs were audible. [synapse.koreamed.org]
It has been suggested that MAC in elderly women can be attributed to ectopic calcium deposits related to the severe bone loss caused by post-menopausal osteoporosis (37). [onlinejacc.org]
A lesion was considered complex if there was plaque extending / 5 mm into the aortic lumen and/or if it was protruding, mobile or ulcerated. [ncbi.nlm.nih.gov]
Patient 3 A 71-year-old woman with a history of hypercholesterolemia and complete hysterectomy for an ovarian tumor had experienced 2 episodes of syncope in the last few months, with no obvious accompanying sweating or nausea. [revespcardiol.org]
Factors which may lead to diagnostic confusion are: (a) failure to identify the posterior mitral leaflet (7/21); (b) diminished anterior leaflet mobility (mean 15 mm); (c) accoustic shadowing of the left ventricular wall (18/21); (d) pseudosystolic anterior [ncbi.nlm.nih.gov]
In these cases it may be heard well at the cardiac base, and could be confused with the murmur of aortic stenosis (AS), but it does not radiate to the carotid arteries. [cardiologyforyou.blogspot.com]
Blood workup has no specific findings in mitral annulus calcification, but it may reveal high cholesterol and glycemia levels, high inflammation markers, as well as indicators of impaired renal function: increased creatinine, potassium, and low glomerular filtration rate.
The diagnosis is made using various imaging methods. The plain thoracic radiography is sometimes able to describe it if calcification is important. Calcium deposits take the shape of the mitral annulus, being observed as "J", "C" or "O" letters. Echocardiography is a much more reliable diagnostic method, describing calcification as a hyperechoic mass or band attached to the anterior or posterior mitral leaflets . More importantly, echocardiography evaluates the degree to which calcification impairs leaflet mobility and causes stenosis or regurgitation, by measuring gradients and determining mitral valve area. Also, this method evaluates the presence of aortic calcification, chamber dilatation, left ventricular hypertrophy and wall kinetics, diastolic mitral flow reversal, this being especially important in individuals that have atrial fibrillation or angina patients. The degree of severity is evaluated in parasternal short axis view: mild (focal), moderate (involving one-third to one-half of the annulus) or severe (more than one-half of the ring is implicated). The mitral valve per se may be difficult to evaluate if calcification is severe because calcium is echo-dense and prevents posterior structures visualization.
When echocardiography raises suspicion of endocarditis, thrombosis or cardiac tumors, cardiac magnetic resonance imaging and computed tomography scanning are useful in establishing the correct diagnosis . Still, these methods are bound by motion artifacts. Multislice (spiral) and electron-beam computed tomography are more effective diagnostic techniques that also apply to the aortic valve. Another visualization method is fluoroscopy performed during coronarography, but this is only used if coronary artery disease is suspected.
- Bifascicular Block
The electrocardiogram (ECG) showed a new bifascicular block. No episodes of advanced atrioventricular blocks or significant pauses were observed in the 24-h Holter-ECG monitoring. [revespcardiol.org]
- Complete Left Bundle Branch Block
This occurs particularly in cases in which CMA extends to the anterior annulus and more medial segments of the posterior annulus and mainly in the form of complete left bundle branch blocks and bifascicular blocks. 7 Nevertheless, the frequency of this [revespcardiol.org]
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