Mitral annular calcification (MAC) is a progressive degenerative calcification of the mitral valve (MV) that is associated with mitral stenosis, regurgitation or both. Patients with MAC are poor candidates for MV surgery because of technical challenges and high peri-operative mortality. Transcatheter MV replacement (TMVR) has emerged as an option for such high surgical risk patients. This has been described with the use of the SAPIEN transcatheter heart valve (valve-in-MAC) and dedicated TMVR devices. Careful anatomic assessment is important to avoid complications of TMVR, such as left ventricular outflow tract obstruction, valve migration, embolization and paravalvular mitral regurgitation. In this review, we discuss the pathology, importance of preprocedural multimodality imaging for optimal patient selection, clinical outcomes and complications associated with TMVR in patients with MAC.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalHeart International
Issue number1
StatePublished - 2023


  • Mitral annular calcification
  • mitral regurgitation
  • mitral stenosis
  • mitral valve
  • mitral valve annuloplasty
  • mitral valve disease
  • mitral valve insufficiency
  • transcatheter mitral valve replacement
  • transcatheter mitral valve therapies
  • vascular calcification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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