Mitral Annular Calcification (MAC)
Mitral annular calcification (MAC) characterized by periannular calcium deposits is a degenerative abnormality commonly seen in the elderly population. Caseous calcification of the mitral annulus (cMAC) is a rare form of mitral annular calcification with central liquefaction necrosis.
Simon M Frey reported a case wherein a 71-year-old female patient had Mitral annular calcification. Tissue characterization with cardiac magnetic resonance (CMR) revealed a cMAC, and a conservative approach was chosen. At follow-up, the patient developed acute hemi occlusion of a retinal artery with cholesterol embolism.
At this time, CMR showed a liquefied cavity of the cMAC. Except for atherosclerotic plaques in the aorta and carotid arteries, further stroke work-up was negative, so the patient was managed conservatively. During follow-up, the liquefied cavity regressed completely after another 6 months, and the patient was free from further events during a 3-year follow-up.
Important Learning Points
- Caseous Mitral annular calcification is a dynamic condition and underestimated as a source of potentially serious complications, such as mitral regurgitation and systemic embolization.
- CMR with multi-parametric tissue characterization can help to diagnose and quantitatively assess the process of liquefaction of MAC.
Source: European Heart Journal - Case Reports
doi-org.eres.qnl.qa/10.1093/ehjcr/ytab380
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