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Mitral Annular Calcification
Suhny Abbara, MD, FACR, FSCCT
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Pathology

        TERMINOLOGY

        • Abbreviations

          • Mitral annular calcification (MAC)
        • Synonyms

          • Annular mitral valve calcification
        • Definitions

          • Chronic degenerative calcification of fibrous mitral valve annulus
          • May develop caseous necrosis

        IMAGING

        • General Features

          • Imaging Recommendations

            • Radiographic Findings

              • CT Findings

                • Echocardiographic Findings

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. O'Neal WT et al: Mitral annular calcification progression and the risk of atrial fibrillation: results from MESA. Eur Heart J Cardiovasc Imaging. 19(3):279-284, 2018
                                        2. Dingli P et al: Caseous mitral annular calcification mimicking a lung tumor on chest X-ray. J Family Med Prim Care. 6(2):442-444, 2017
                                        3. Chan V et al: Impact of mitral annular calcification on early and late outcomes following mitral valve repair of myxomatous degeneration. Interact Cardiovasc Thorac Surg. 17(1):120-5, 2013
                                        4. Higgins J et al: Cardiac computed tomography facilitates operative planning in patients with mitral calcification. Ann Thorac Surg. 95(1):e9-11, 2013
                                        5. Okada Y: Surgical management of mitral annular calcification. Gen Thorac Cardiovasc Surg. Epub ahead of print, 2013
                                        6. Eller P et al: Impact of ENPP1 genotype on arterial calcification in patients with end-stage renal failure. Nephrol Dial Transplant. 23(1):321-7, 2008
                                        7. d'Alessandro C et al: Mitral annulus calcification: determinants of repair feasibility, early and late surgical outcome. Eur J Cardiothorac Surg. 32(4):596-603, 2007
                                        8. Lubarsky L et al: Images in cardiovascular medicine. Caseous calcification of the mitral annulus by 64-detector-row computed tomographic coronary angiography: a rare intracardiac mass. Circulation. 116(5):e114-5, 2007
                                        9. Poh KK et al: Prominent posterior mitral annular calcification causing embolic stroke and mimicking left atrial fibroma. Eur Heart J. 28(18):2216, 2007
                                        10. Sharma R et al: Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease. Atherosclerosis. 191(2):348-54, 2007
                                        11. Cury RC et al: Epidemiology and association of vascular and valvular calcium quantified by multidetector computed tomography in elderly asymptomatic subjects. Am J Cardiol. 94(3):348-51, 2004
                                        12. Atar S et al: Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old. Heart. 89(2):161-4, 2003
                                        13. Fox CS et al: Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation. 107(11):1492-6, 2003
                                        14. Adler Y et al: Mitral annulus calcification--a window to diffuse atherosclerosis of the vascular system. Atherosclerosis. 155(1):1-8, 2001
                                        15. Harpaz D et al: Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. J Am Soc Echocardiogr. 14(8):825-31, 2001
                                        16. Carpentier AF et al: Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg. 111(4):718-29; discussion 729-30, 1996
                                        17. Maher ER et al: Aortic and mitral valve calcification in patients with end-stage renal disease. Lancet. 2(8564):875-7, 1987
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              TERMINOLOGY

                                              • Abbreviations

                                                • Mitral annular calcification (MAC)
                                              • Synonyms

                                                • Annular mitral valve calcification
                                              • Definitions

                                                • Chronic degenerative calcification of fibrous mitral valve annulus
                                                • May develop caseous necrosis

                                              IMAGING

                                              • General Features

                                                • Imaging Recommendations

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • Echocardiographic Findings

                                                        • MR Findings

                                                          DIFFERENTIAL DIAGNOSIS

                                                            PATHOLOGY

                                                            • General Features

                                                              • Gross Pathologic & Surgical Features

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Demographics

                                                                      • Natural History & Prognosis

                                                                        • Treatment

                                                                          DIAGNOSTIC CHECKLIST

                                                                          • Consider

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. O'Neal WT et al: Mitral annular calcification progression and the risk of atrial fibrillation: results from MESA. Eur Heart J Cardiovasc Imaging. 19(3):279-284, 2018
                                                                              2. Dingli P et al: Caseous mitral annular calcification mimicking a lung tumor on chest X-ray. J Family Med Prim Care. 6(2):442-444, 2017
                                                                              3. Chan V et al: Impact of mitral annular calcification on early and late outcomes following mitral valve repair of myxomatous degeneration. Interact Cardiovasc Thorac Surg. 17(1):120-5, 2013
                                                                              4. Higgins J et al: Cardiac computed tomography facilitates operative planning in patients with mitral calcification. Ann Thorac Surg. 95(1):e9-11, 2013
                                                                              5. Okada Y: Surgical management of mitral annular calcification. Gen Thorac Cardiovasc Surg. Epub ahead of print, 2013
                                                                              6. Eller P et al: Impact of ENPP1 genotype on arterial calcification in patients with end-stage renal failure. Nephrol Dial Transplant. 23(1):321-7, 2008
                                                                              7. d'Alessandro C et al: Mitral annulus calcification: determinants of repair feasibility, early and late surgical outcome. Eur J Cardiothorac Surg. 32(4):596-603, 2007
                                                                              8. Lubarsky L et al: Images in cardiovascular medicine. Caseous calcification of the mitral annulus by 64-detector-row computed tomographic coronary angiography: a rare intracardiac mass. Circulation. 116(5):e114-5, 2007
                                                                              9. Poh KK et al: Prominent posterior mitral annular calcification causing embolic stroke and mimicking left atrial fibroma. Eur Heart J. 28(18):2216, 2007
                                                                              10. Sharma R et al: Mitral annular calcification predicts mortality and coronary artery disease in end stage renal disease. Atherosclerosis. 191(2):348-54, 2007
                                                                              11. Cury RC et al: Epidemiology and association of vascular and valvular calcium quantified by multidetector computed tomography in elderly asymptomatic subjects. Am J Cardiol. 94(3):348-51, 2004
                                                                              12. Atar S et al: Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old. Heart. 89(2):161-4, 2003
                                                                              13. Fox CS et al: Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation. 107(11):1492-6, 2003
                                                                              14. Adler Y et al: Mitral annulus calcification--a window to diffuse atherosclerosis of the vascular system. Atherosclerosis. 155(1):1-8, 2001
                                                                              15. Harpaz D et al: Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. J Am Soc Echocardiogr. 14(8):825-31, 2001
                                                                              16. Carpentier AF et al: Extensive calcification of the mitral valve anulus: pathology and surgical management. J Thorac Cardiovasc Surg. 111(4):718-29; discussion 729-30, 1996
                                                                              17. Maher ER et al: Aortic and mitral valve calcification in patients with end-stage renal disease. Lancet. 2(8564):875-7, 1987