I have outlined an overview of MAC and highlighted the relevance to our patient who had CAD.(Abramovitz is an excellent article if you have time)
The relationship of the aortic and mitral valve goes back a long way (for your own interest I wrote a little poem about the relationship)
re the Aortic Annular Calcification Suffice just to mention that is related to atherosclerosis in other vascular beds. (as is MAC)
Examples
Our Case
MAC IHD and Prior Infarction
The fat and calcium in the LV apex indicates prior MI
Extensive MAC with heart block MR and mild MS
MAC and Caseous Necrosis
MAC Dextrocardia and Bacterial Endocarditis
Start here
Mitral Annular Calcification
Degenerative process associated with
aging,
cardiovascular risk factors.
Degeneration from increased mitral valve stress
Aortic Stenosis
Hypertension
Hypertrophic Cardiomyopathy
Also seen in
chronic kidney disease, (Ca PO4 disorder)
following radiation therapy.
Associated with
arrhythmias and heart blocks
MS and MR are rare
Our Case
Mitral Annulus and Aortic Annulus Calcification
Location 3
MITRAL ANNULAR AND AORTIC ANNULAR CALCIFICATION
Other Examples
MAC and IHD
Location 3
MAC and IHD – FAT AND CALCIUM IN THE HEART 56 year old male with history of coronary artery disease. Axial CT through the heart shows apical curvilinear fat (yellow arrowheads, ( a and b) associated with apical myocardial dystrophic calcification (green arrowheads c and d) both indicating prior apical MI. In addition there mitral annular calcification (red arrowhead, b) and multifocal fatty deposits in the RV (white arrowheads, a and b) usually depicting age related degenerative changes. The calcification in the annulus is premature and unusual for this 56 year old male patient. Note the small bilateral pleural effusion The association of atherosclerosis and MAC are well known. Premature MAC should therefore be a warning for premature heart disease. Ashley Davidoff MD
Examples of Uncommon Complications
Heart Block, MR and MS
Location 3
SEVERE MITRAL ANNULAR CALCIFICATION Axial CT through the mitral annulus shows severe mitral annular calcification extending into the ventricular cavity and the ventricular septum.
MAC and Caseous Necrosis
Location 3
MAC and CASEOUS NECROSIS 69 year old female with MAC who presents with an echo finding of a mass on the mitral valve thought to represent a myxoma. CT confirmed a low-density mass measuring in the soft tissue range associated with mitral annular calcification.
Location 3
MAC and CASEOUS NECROSIS T1 BRIGHT . MRI showed a mass in the region of the posterior leaflet of the MV with T2 hyperintensity suggesting aqueous component and T1 hyperintensity suggesting increased protein content. There was no enhancement of the lesion. Peripheral T1 and T2 low intensity reflects calcification. A diagnosis of caseous necrosis of MAC is most likely
Location 3
MAC and CASEOUS NECROSIS T2 BRIGHT MRI showed a mass in the region of the posterior leaflet of the MV with T2 hyperintensity suggesting aqueous component (upper image) and focal T1 low intensity nodule on the posterior leaflet reflects the MAC There was no enhancement of the lesion. A diagnosis of caseous necrosis of MAC is most likely
Abramovitz Y et al Mitral Annulus Calcification. J Am Coll Cardiol 2015;66:1934-1941. (excellent review)
Allison M, et al Mitral and Aortic Annular Calcification Are Highly Associated With Systemic Calcified Atherosclerosis Circulation Vol. 113, No. 6
Rodriguez C et alAssociation of Annular Calcification and Aortic Valve Sclerosis With Brain Findings on Magnetic Resonance Imaging in Community Dwelling Older Adults
