scholarly journals Immediate outcomes of treatment of severe mitral annular calcification

2021 ◽  
Vol 23 (2) ◽  
pp. 52-59
Author(s):  
R. M. Muratov ◽  
M. N. Sorcomov ◽  
A. S. Sachkov ◽  
S. I. Babenko ◽  
A. M. Sleptsova ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Annulus Fibrosus ◽  
Posterior Wall ◽  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Calcium Deposition ◽  
Mitral Annular Calcification ◽  
Valve Function ◽  
Annular Calcification

Mitral annular calcification (MAC) is a chronic degenerative process involving the fibrous part of the mitral complex, characterized by calcium deposition and loss of valve function. MAC prevalence is 8–10%, but despite this, the clinical significance of MAC is underestimated. Currently, there are reports that complete decalcification leads to improved long-term outcomes in patients with severe MAC. An analysis of the immediate outcomes of mitral valve surgery in patients with severely calcified mitral annulus with decalcification was performed. The calcified annulus fibrosus underwent complete decalcification in all cases. Calcium deposits were removed in a single block, in 6 cases it was reconstructed with a xeno-pericardial patch; in 2 cases the annulus fibrosus was sutured. There were 2 cases of in-hospital mortality, caused by acute heart failure on day 8 in 1 patient and pulmonary embolism on day 30 after operation in the second patient. There were no complications associated with coronary artery injury and left ventricular posterior wall rupture. Experience in the treatment of severe mitral valve calcification with extensive annulus fibrosus decalcification and subsequent reconstruction is possible and gives satisfactory results.

scholarly journals Morphological features of mitral annular calcification leading to systolic anterior motion of the mitral valve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E J Friend ◽  
P C Wiener ◽  
K Murthy ◽  
G S Pressman
Keyword(s):  
Mitral Valve ◽  
Interventricular Septum ◽  
Mitral Annulus ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Systolic Anterior Motion ◽  
Mitral Leaflet ◽  
Mitral Annular Calcification ◽  
Anterior Mitral Leaflet ◽  
Annular Calcification

Abstract Background Systolic anterior motion (SAM) of the mitral valve (MV) can develop after mitral valve repair with placement of an annuloplasty ring. It is occasionally seen in patients with mitral annular calcification (MAC) but mechanisms have not been carefully delineated. Using 2-dimensional echocardiography we explored morphologic parameters which may contribute to SAM in patients with MAC. Hypothesis We hypothesized that in cases of MAC where SAM is present there would be anterior displacement of the valve by the posterior annular calcification. Methods From our echocardiographic database we identified 20 patients with severe MAC who also had SAM with definite septal contact. Each subject was paired with 2 controls free of MAC and 1 control with severe MAC but no SAM. All controls were matched for age, sex, BSA, and septal wall thickness (±1.5 mm). 2-D echocardiographic measurements were taken from the parasternal long-axis (PLAX), apical 3-chamber and apical 4-chamber views. Results MAC+SAM vs MAC no-SAM. Three notable differences were observed: MAC+SAM patients, as compared with MAC no-SAM, had a smaller left ventricular outflow tract (LVOT), longer anterior mitral leaflet, and greater displacement of the MV coaptation point towards the interventricular septum (Figure 1). Median values for these 3 factors were determined using the no-MAC controls; each MAC subject was then scored for number of factors exceeding those values. MAC+SAM patients had a mean score of 2.7 vs 1.1 for MAC no-SAM patients. By combining anterior mitral leaflet length and coaptation point-septal distance as a ratio we could effectively separate MAC+SAM vs MAC no-SAM when >0.9 with one exception (Figure 2). We also observed a smaller anteroposterior annular dimension in the MAC+SAM group. MAC no-SAM vs no-MAC. Comparing these groups there were no differences in LVOT diameter or coaptation-septal distance; effective anterior mitral leaflet length was smaller in MAC no-SAM subjects vs no-MAC controls while anteroposterior dimension of the annulus was larger. Conclusions SAM develops in a subset of patients with severe calcification of the mitral annulus. These patients have a smaller anteroposterior annular dimension, possibly due to severe MAC. Other notable differences characterize MAC patients with SAM from those without. The LVOT is smaller, the effective anterior mitral leaflet length is longer, and the point of leaflet coaptation is displaced towards the septum. Using the ratio of anterior mitral leaflet length/coaptation point-septal distance in this study sample effectively separated those MAC patients with SAM from those without. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Coordinate-Free Analysis of Mitral Valve Dynamics in Normal and Ischemic Hearts

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Paul Dagum ◽  
Tomasz A. Timek ◽  
G. Randall Green ◽  
David Lai ◽  
George T. Daughters ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Color Doppler ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Free System ◽  
Ring Annuloplasty ◽  
3D Geometry ◽  
Valve Function ◽  
Valve Dynamics ◽  
Radiopaque Markers

Background —The purpose of this investigation was to study mitral valve 3D geometry and dynamics by using a coordinate-free system in normal and ischemic hearts to gain mechanistic insight into normal valve function, valve dysfunction during ischemic mitral regurgitation (IMR), and the treatment effects of ring annuloplasty. Methods and Results —Radiopaque markers were implanted in sheep: 9 in the ventricle, 1 on each papillary tip, 8 around the mitral annulus, and 1 on each leaflet edge midpoint. One group served as a control (n=7); all others underwent flexible Tailor partial (n=5) or Duran complete (n=6) ring annuloplasty. After an 8±2-day recovery, 3D marker coordinates were measured with biplane videofluoroscopy before and during posterolateral left ventricular ischemia, and MR was assessed by color Doppler echocardiography. Papillary to annular distances remained constant throughout the cardiac cycle in normal hearts, during ischemia, and after ring annuloplasty with either type of ring. Papillary to leaflet edge distances similarly remained constant throughout ejection. During ischemia, however, the absolute distances from the papillary tips to the annulus changed in a manner consistent with leaflet tethering, and IMR was observed. In contrast, during ischemia in either ring group, those distances did not change from preischemia, and no IMR was observed. Conclusions —This analysis uncovered a simple pattern of relatively constant intracardiac distances that describes the 3D geometry and dynamics of the papillary tips and leaflet edges from the dynamic mitral annulus. Ischemia perturbed the papillary-annular distances, and IMR occurred. Either type of ring annuloplasty prevented such changes, preserved papillary-annular distances, and prevented IMR.

Mitral annular calcification and valvular dysfunction: multimodality imaging evaluation, grading, and management

2021 ◽  
Author(s):  
Bo Xu ◽  
Duygu Kocyigit ◽  
Tom Kai Ming Wang ◽  
Carmela D Tan ◽  
E Rene Rodriguez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Classification System ◽  
Multimodality Imaging ◽  
Imaging Modality ◽  
Cardiac Computed Tomography ◽  
Calcium Deposition ◽  
Mitral Annular Calcification ◽  
Imaging Evaluation ◽  
Line Imaging ◽  
Annular Calcification

Abstract Mitral annular calcification (MAC) refers to calcium deposition in the fibrous skeleton of the mitral valve. It has many cardiovascular associations, including mitral valve dysfunction, elevated cardiovascular risk, arrhythmias, and endocarditis. Echocardiography conventionally is the first-line imaging modality for anatomic assessment, and evaluation of mitral valve function. Cardiac computed tomography (CT) has demonstrated importance as an imaging modality for the evaluation and planning of related procedures. It also holds promise in quantitative grading of MAC. Currently, there is no universally accepted definition or classification system of MAC severity. We review the multimodality imaging evaluation of MAC and associated valvular dysfunction and propose a novel classification system based on qualitative and quantitative measurements derived from echocardiography and cardiac CT.

Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement in Severe Mitral Annular Calcification: An Analysis of the Transcatheter Mitral Valve Replacement in Mitral Annular Calcification Global Registry

2021 ◽  
Vol 14 (10) ◽  
Author(s):  
Abdallah El Sabbagh ◽  
Mohammed Al-Hijji ◽  
Dee Dee Wang ◽  
Mackram Eleid ◽  
Marina Urena ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Multidetector Row Computed Tomography ◽  
Mitral Annular Calcification ◽  
Transcatheter Mitral Valve Replacement ◽  
Annular Calcification

Background: Several studies have evaluated preprocedural imaging predictors of left ventricular outflow tract obstruction (LVOTO) after transcatheter mitral valve replacement. The patient cohorts in these studies were heterogeneous and included patients with transcatheter mitral valve replacement in failed bioprostheses, annuloplasty rings, and severe mitral annular calcification (MAC). The goal of this study was to evaluate predictors of LVOTO specific to patients undergoing valve-in-MAC. Methods: This study included patients with severe MAC who underwent valve-in-MAC and had optimal quality preprocedural multidetector row computed tomography scans eligible for retrospective analysis. Baseline demographic, echocardiographic, and procedural data on these patients were collected. multidetector row computed tomography parameters were analyzed for association with LVOTO, defined as increase in mean LVOT gradient by ≥10 mm Hg with accompanying hemodynamic instability. Results: Seventy-one patients with optimal preprocedural computed tomography scans were included in this study (mean age, 72.5±13.5 years), 9 of which developed LVOTO (all female). Baseline mean LVOT area, neo-LVOT area (145.3 versus 270.9 mm 2 ; P =0.006), indexed neo-LVOT area (90.1 versus 157.4; P =0.05), and virtual transcatheter heart valve to septum distance (3.1 versus 6.9 mm; P =0.002) were lower in the LVOTO group. Expected % LVOT area reduction was higher in the latter group (58.3 versus 42.7%; P =0.008). In the univariable analysis, the baseline mean LVOT area, neo-LVOT area, indexed neo-LVOT area, and valve to septum distance were all significantly associated with LVOTO. Conclusions: The systolic mean LVOT area, neo-LVOT area, indexed neo-LVOT, expected percentage LVOT area reduction, and the valve to septum distance were associated with LVOTO after valve-in-MAC.

Cavitron ultrasonic surgical aspirator for mitral annular decalcification

2021 ◽  
Keyword(s):  
Mitral Annulus ◽  
Mitral Valve Surgery ◽  
Mitral Annular Calcification ◽  
Video Tutorial ◽  
Cavitron Ultrasonic Surgical Aspirator ◽  
Consensus Strategy ◽  
Annular Calcification ◽  
Ultrasonic Surgical Aspirator ◽  
Patient Presentation ◽  
Severe Calcification

Mitral valve surgery can be especially difficult in patients with mitral annular calcification. Not only is it associated with higher morbidity and mortality, but there is no consensus strategy for the treatment of mitral annular calcification, which may render some patients inoperable. We describe a case of severe mitral annular calcification successfully treated with the cavitron ultrasonic surgical aspirator. We demonstrate the proper technique for and the efficacy of using this instrument for decalcification of the mitral annulus. The video tutorial includes the patient presentation, preoperative and postoperative imaging, and the proper surgical technique for cavitron ultrasonic surgical aspirator-assisted mitral annular decalcification. With the proper technique, the cavitron ultrasonic surgical aspirator may mitigate the risk of surgical complications associated with severe calcification of the mitral annulus.

Abstract 17000: Quantifying Mitral Annular Calcification Using Echocardiography: Comparison to MAC Calcium Score From Gated Computed Tomography

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
William Harvey ◽  
Sheldon Litwin
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Calcium Score ◽  
Mitral Annulus ◽  
Atrial Volume ◽  
Mitral Annular Calcification ◽  
Close Proximity ◽  
Annular Calcification

Introduction: Mitral Annular Calcification (MAC) is present in 25-40% of people ≥ 60 years old and has associations with atrial fibrillation, stroke, endocarditis, mitral regurgitation, and mitral stenosis. MAC poses major challenges to surgical or transcatheter mitral valve interventions. Current echocardiographic methods for assessing MAC are limited. Goals: To assess transthoracic echocardiographic (TTE) approaches for quantifying MAC severity compared to a gold standard of MAC calcium score by gated computed tomography (CT). Methods: 75 patients undergoing evaluation for TAVR had TTE and CT in close proximity. MAC area and circumference were measured in parasternal long-axis (PLAX), parasternal short-axis (PSAX), and apical 2, 3, and 4-chamber views on TTE. Mitral valve gradients and left atrial volume were recorded. The curvilinear length of MAC in the PSAX view on TTE and cardiac CT were also measured. Associations between various TTE measures and MAC calcium score were assessed using linear regression. Results: Median age was 75.3, 50.4% female, 85.3% Caucasian. MAC area and circumference in PSAX on TTE showed moderate correlations (R 2 =0.32-0.37) with MAC calcium score. Curvilinear MAC length measures on SAX TTE and CT had improved correlation with MAC score (R 2 =0.41 & 0.78, Figure). Combined circumference of MAC from PLAX+PSAX had the strongest association (R 2 = 0.48). Interobserver variability on CT and TTE had coefficients of variation ranging 17-37%. Left atrial volume and mitral valve gradients had weak associations with MAC severity (R 2 =0.03-0.12). Tertiles of MAC calcium scores were 2650, 5150 and 7750. Conclusions: MAC length in the PSAX view showed the strongest association with MAC severity. Dedicated PSAX views of the mitral annulus may improve the ability to reproducibly grade MAC severity by echo.

Sign in / Sign up

Export Citation Format

Share Document