Mitral Annulus Calcification

Yigal Abramowitz, Hasan Jilaihawi, Tarun Chakravarty, Michael J. Mack, Raj R. Makkar

Research output: Contribution to journalReview articlepeer-review

170 Scopus citations


Mitral annulus calcification (MAC) is a chronic, degenerative process in the fibrous base of the mitral valve. Although MAC was initially thought to be an age-related degenerative process, there is accumulating evidence that other mechanisms, such as atherosclerosis and abnormal calcium-phosphorus metabolism, also contribute to the development of MAC. Despite its frequency, the clinical relevance of MAC is grossly underappreciated. Indeed, MAC is associated with an increased incidence of cardiovascular disease, mitral valve disease, arrhythmias, and mortality. MAC also influences the outcomes of cardiac surgery and interventions, and its clinical relevance may well increase substantially in the forthcoming era of transcatheter mitral valve replacement. In this paper, we review the available published data to provide a consistent, clinically relevant description of MAC on the basis of contemporary imaging. We describe the pathophysiological mechanisms contributing to the formation of MAC and the clinical implications of this disease entity.

Original languageEnglish
Pages (from-to)1934-1941
Number of pages8
JournalJournal of the American College of Cardiology
Issue number17
StatePublished - 27 Oct 2015
Externally publishedYes


  • calcified
  • cardiovascular diseases
  • mitral annular calcification
  • mitral valve
  • valvular calcification


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