Purpose of Review

Mitral annular calcification (MAC) is associated with cardiovascular comorbidities and events and in the presence of mitral stenosis (MS) represents a high-risk cohort with limited treatment options. Emerging hybrid, minimally invasive, and transcatheter therapies that use circumferential MAC as an anchor for mitral valve replacement are emerging, but none are consistently associated with ideal outcomes.

Recent Findings

In patients with MAC and nonrheumatic calcific mitral stenosis who are severely symptomatic, mitral intervention may be indicated. Surgical decalcification and replacement of the mitral valve remains the conventional therapy. Surgical techniques to avoid decalcification are being described including a left atrium to left ventricular apex graft conduit. Transcatheter balloon-expandable valves designed for the aortic valve have been implanted in the mitral position in MAC with a surgical direct transatrial transcatheter approach or transseptal transcatheter approach. Left ventricular outflow tract (LVOT) obstruction remains prevalent and associated with increased mortality. Direct transatrial approach allows for surgical resection of the anterior leaflet to mitigate this risk, and percutaneous therapies to lacerate the anterior leaflet or to ablate the basal septum are being developed. Cardiac computed tomography has emerged as a requisite for patient selection and procedural planning and has powerful predictive value for LVOT obstruction and valve embolization in valve-in-MAC. Novel transcatheter valves designed specifically for the mitral space are being studied in patients with MAC.

Summary

MAC with mitral stenosis remains a challenging disease. Advances in technique, technology, and imaging may create new and reproducible treatment options with low procedural mortality for this challenging disease entity.

中文翻译：

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如何治疗二尖瓣环钙化引起的二尖瓣狭窄

审查目的

二尖瓣环钙化 (MAC) 与心血管合并症和事件相关，并且在存在二尖瓣狭窄 (MS) 的情况下，这是一个治疗选择有限的高风险队列。新兴的混合、微创和经导管疗法正在出现，它们使用圆周 MAC 作为二尖瓣置换的锚点，但没有一种始终与理想的结果相关联。

最近的发现

对于有严重症状的 MAC 和非风湿性钙化性二尖瓣狭窄患者，可能需要进行二尖瓣干预。二尖瓣的手术脱钙和置换仍然是常规疗法。正在描述避免脱钙的手术技术，包括左心房到左心室心尖移植物导管。为主动脉瓣设计的经导管球囊扩张瓣膜已通过手术直接经心房经导管入路或经中隔经导管入路植入 MAC 的二尖瓣位置。左心室流出道 (LVOT) 阻塞仍然普遍存在并与死亡率增加相关。直接经房入路允许手术切除前叶以减轻这种风险，并且正在开发用于撕裂前叶或消融基底隔膜的经皮疗法。心脏计算机断层扫描已成为患者选择和程序规划的必要条件，并且对 MAC 瓣膜中的 LVOT 阻塞和瓣膜栓塞具有强大的预测价值。专门为二尖瓣设计的新型经导管瓣膜正在 MAC 患者中进行研究。

概括

伴有二尖瓣狭窄的 MAC 仍然是一种具有挑战性的疾病。技术、技术和影像学的进步可能会为这种具有挑战性的疾病实体创造新的、可重复的治疗方案，其手术死亡率较低。