Mitral Annular Calcification.

Mitral annular calcification (MAC) is a chronic degenerative process strongly associated with aging that predominantly affects the posterior mitral annulus. Its pathogenesis is linked to traditional cardiovascular risk factors that increase mechanical stress and inflammation, promoting pathological cellular differentiation within the annulus. MAC prevalence in the general population is approximately 8-15%, with 8% of affected patients developing clinically significant valvular disease, defined as mitral stenosis or moderate or greater mitral regurgitation. Patients with MAC are at higher risk of cardiovascular mortality and complications, including the development of atrial fibrillation, the development of conduction disorders, and often have signs of coronary or systemic atherosclerosis. Transthoracic echocardiogram remains the first-line imaging modality for the diagnosis of MAC, while cardiac-gated computed tomography is valuable for quantifying severity and progression while also guiding procedural planning. Though management is often conservative, in patients who have clinically significant valvular dysfunction, MAC can present a challenge when planning valvular interventions, and a multidisciplinary approach is often required.