{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:36:26Z","timestamp":1788690986372,"version":"build-2803163510"},"reference-count":78,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T00:00:00Z","timestamp":1706918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Mitral valve annular calcification-related valvular disease is increasingly common due to the rising prevalence of age-related mitral annular calcifications. Mitral annular calcification alters the structure and function of the mitral valve annulus, which in turn causes mitral valve regurgitation, stenosis, or both. As it frequently coexists with comorbid conditions and overlapping symptoms, mitral annular calcification-related valvular disease poses significant diagnostic and therapeutic challenges. For instance, left ventricular diastolic dysfunction hinders the assessment of mitral valvular disease. Detection of mitral annular calcifications and assessment of related mitral valve disease hinge on two-dimensional echocardiography. Comprehensive assessment of mitral annular calcifications and related mitral valve disease may require multidetector computed tomography and three-dimensional echocardiography. Invasive hemodynamic testing with exercise helps identify the cause of symptoms in patients with comorbid conditions, and transcatheter interventions have emerged as a viable therapeutic option for older patients. After an outline of the normal mitral annulus, we examine how mitral annular calcifications lead to mitral valve disease and how to accurately assess mitral regurgitation and stenosis. Lastly, we review surgical and transcatheter approaches to the management of mitral annular calcification-related mitral valve regurgitation, stenosis, or both.<\/jats:p>","DOI":"10.3390\/jcm13030896","type":"journal-article","created":{"date-parts":[[2024,2,6]],"date-time":"2024-02-06T12:38:24Z","timestamp":1707223104000},"page":"896","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Mitral Annular Calcification-Related Valvular Disease: A Challenging Entity"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2002-8997","authenticated-orcid":false,"given":"Abdulrahman S.","family":"Museedi","sequence":"first","affiliation":[{"name":"Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3315-6880","authenticated-orcid":false,"given":"Thierry H.","family":"Le Jemtel","sequence":"additional","affiliation":[{"name":"Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1056\/NEJM199208063270602","article-title":"Mitral annular calcification and the risk of stroke in an elderly cohort","volume":"327","author":"Benjamin","year":"1992","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ahj.2005.03.052","article-title":"Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly. The Cardiovascular Health Study (CHS)","volume":"151","author":"Barasch","year":"2006","journal-title":"Am. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1016\/j.ahj.2004.05.048","article-title":"Epidemiology of mitral annular calcification and its predictive value for coronary events in African Americans: The Jackson Cohort of the Atherosclerotic Risk in Communities Study","volume":"148","author":"Fox","year":"2004","journal-title":"Am. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1111\/echo.15236","article-title":"Prevalence of mitral annular calcification and its association with mitral valvular disease","volume":"38","author":"Okura","year":"2021","journal-title":"Echocardiography"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.mayocp.2021.12.015","article-title":"Prevalence and Natural History of Mitral Annulus Calcification and Related Valve Dysfunction","volume":"97","author":"Kato","year":"2022","journal-title":"Mayo Clin. Proc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1016\/j.jacc.2015.08.872","article-title":"Mitral Annulus Calcification","volume":"66","author":"Abramowitz","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1136\/heart.89.2.161","article-title":"Mitral annular calcification: A marker of severe coronary artery disease in patients under 65 years old","volume":"89","author":"Atar","year":"2003","journal-title":"Heart"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1016\/S0002-9149(98)00596-7","article-title":"Mitral annular calcium detected by transthoracic echocardiography is a marker for high prevalence and severity of coronary artery disease in patients undergoing coronary angiography","volume":"82","author":"Adler","year":"1998","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1093\/ndt\/13.8.2037","article-title":"Cardiac valve calcification in haemodialysis patients: Role of calcium-phosphate metabolism","volume":"13","author":"Ribeiro","year":"1998","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Olsen, F.J., Diederichsen, S.Z., J\u00f8rgensen, P.G., Jensen, M.T., Dahl, A., Landler, N.E., Graff, C., Brandes, A., Krieger, D., and Haugan, K. (2022). Potential role of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in elderly individuals: Baseline echocardiographic findings from the LOOP study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0269475"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.tcm.2019.07.011","article-title":"Mechanisms of mitral annular calcification","volume":"30","author":"Massera","year":"2020","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e008513","DOI":"10.1161\/CIRCIMAGING.118.008513","article-title":"Disease Activity in Mitral Annular Calcification","volume":"12","author":"Massera","year":"2019","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1161\/01.CIR.0000099542.57313.C5","article-title":"Human epicardial adipose tissue is a source of inflammatory mediators","volume":"108","author":"Mazurek","year":"2003","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e921553","DOI":"10.12659\/MSM.921553","article-title":"Epicardial Adipose Tissue Predicts Severe Mitral Annular Calcification in Patients Aged \u2265 60 Years","volume":"26","author":"Argan","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.ahj.2009.10.014","article-title":"Contemporary insights into the functional anatomy of the mitral valve","volume":"158","author":"Silbiger","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ahj.2012.05.014","article-title":"Anatomy, mechanics, and pathophysiology of the mitral annulus","volume":"164","author":"Silbiger","year":"2012","journal-title":"Am. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.cjca.2014.06.022","article-title":"Basic mechanisms of mitral regurgitation","volume":"30","author":"Beaudoin","year":"2014","journal-title":"Can. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1016\/j.echo.2015.03.002","article-title":"Mitral Annular Dynamics in Mitral Annular Calcification: A Three-Dimensional Imaging Study","volume":"28","author":"Pressman","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1016\/j.amjcard.2016.07.044","article-title":"Mitral Annular Calcium and Mitral Stenosis Determined by Multidetector Computed Tomography in Patients Referred for Aortic Stenosis","volume":"118","author":"Mejean","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/S0022-5223(96)70332-X","article-title":"Extensive calcification of the mitral valve anulus: Pathology and surgical management","volume":"111","author":"Carpentier","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.jacc.2022.05.032","article-title":"Mitral Valve Dysfunction in Patients with Annular Calcification: JACC Review Topic of the Week","volume":"80","author":"Churchill","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.echo.2022.05.007","article-title":"Natural History of Mitral Annular Calcification and Calcific Mitral Valve Disease","volume":"35","author":"Willner","year":"2022","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e030620","DOI":"10.1161\/JAHA.123.030620","article-title":"Risk Factors and Outcomes with Progressive Mitral Annular Calcification","volume":"12","author":"Lee","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jaccas.2020.09.039","article-title":"The Spectrum of Caseous Mitral Annulus Calcifications","volume":"3","author":"Mayr","year":"2021","journal-title":"JACC Case Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1161\/01.CIR.0000058168.26163.BC","article-title":"Mitral annular calcification predicts cardiovascular morbidity and mortality: The Framingham Heart Study","volume":"107","author":"Fox","year":"2003","journal-title":"Circulation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1016\/j.jcin.2023.06.044","article-title":"Diagnosis, Classification, and Management Strategies for Mitral Annular Calcification: A Heart Valve Collaboratory Position Statement","volume":"16","author":"Guerrero","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1016\/j.athoracsur.2010.06.116","article-title":"Mitral valve morphology assessment: Three-dimensional transesophageal echocardiography versus computed tomography","volume":"90","author":"Shanks","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4250\/jcvi.2022.0043","article-title":"Utility of Multidetector Computed Tomographic Angiography as an Alternative to Transesophageal Echocardiogram for Preoperative Transcatheter Mitral Valve Repair Planning","volume":"31","author":"Basman","year":"2023","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.echo.2022.03.018","article-title":"Novel Three-Dimensional Transesophageal Echocardiographic Method for Mapping Mitral Annular Calcifications","volume":"35","author":"Prandi","year":"2022","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Prandi, F.R., Romeo, F., Barilla, F., Sharma, S., Kini, A., and Lerakis, S. (2023). Novel 3D Echocardiographic Technique for Mitral Calcium Mapping. J. Clin. Med., 12.","DOI":"10.3390\/jcm12041470"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1016\/j.jcmg.2020.03.013","article-title":"A Cardiac Computed Tomography-Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization","volume":"13","author":"Guerrero","year":"2020","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3048","DOI":"10.1016\/j.jacc.2020.04.049","article-title":"The Natural History of Severe Calcific Mitral Stenosis","volume":"75","author":"Kato","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4321","DOI":"10.1093\/eurheartj\/ehaa819","article-title":"Prognostic importance of the transmitral pressure gradient in mitral annular calcification with associated mitral valve dysfunction","volume":"41","author":"Bertrand","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1161\/CIRCULATIONAHA.119.040095","article-title":"Complexity of Defining Severe \u201cStenosis\u201d from Mitral Annular Calcification","volume":"140","author":"Reddy","year":"2019","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1161\/HYPERTENSIONAHA.121.17339","article-title":"Left Atrioventricular Coupling Index as a Prognostic Marker of Cardiovascular Events: The MESA Study","volume":"78","author":"Pezel","year":"2021","journal-title":"Hypertension"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.echo.2021.04.007","article-title":"Mitral Annular Calcification and Calcific Mitral Stenosis: Role of Echocardiography in Hemodynamic Assessment and Management","volume":"34","author":"Silbiger","year":"2021","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.amjcard.2015.12.010","article-title":"Effect of Mitral Annular Calcium on Left Ventricular Diastolic Parameters","volume":"117","author":"Codolosa","year":"2016","journal-title":"Am. J. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1016\/j.jcmg.2016.09.001","article-title":"Severe Mitral Annular Calcification: Multimodality Imaging for Therapeutic Strategies and Interventions","volume":"9","author":"Eleid","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1161\/01.CIR.60.5.1096","article-title":"Noninvasive assessment of atrioventricular pressure half-time by Doppler ultrasound","volume":"60","author":"Hatle","year":"1979","journal-title":"Circulation"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1111\/echo.14495","article-title":"Degenerative mitral valve stenosis: Diagnosis and management","volume":"36","author":"Almahmoud","year":"2019","journal-title":"Echocardiography"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Monteagudo Ruiz, J.M., and Zamorano Gomez, J.L. (2021). The Role of 2D and 3D Echo in Mitral Stenosis. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8120171"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.echo.2008.05.010","article-title":"Assessing mitral valve area and orifice geometry in calcific mitral stenosis: A new solution by real-time three-dimensional echocardiography","volume":"21","author":"Chu","year":"2008","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1093\/ehjci\/jex056","article-title":"Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A transoesophageal 3D colour Doppler analysis in 500 patients","volume":"19","author":"Goebel","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1056\/NEJMoa1109034","article-title":"Genetic associations with valvular calcification and aortic stenosis","volume":"368","author":"Thanassoulis","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Ahmad, S., Yousaf, A., Ghumman, G.M., Dvalishvili, M., Ahsan, M.J., Dilibe, A., Reis, H.L., Qavi, A.H., Szerlip, M., and Goldsweig, A.M. (2023). Outcomes of transcatheter aortic valve replacement in patients with mitral annular calcification and concomitant mitral valve dysfunction: A systematic review and meta-analysis. Cardiovasc. Revasc Med.","DOI":"10.1016\/j.carrev.2023.10.010"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1093\/ehjci\/jez208","article-title":"Does isolated mitral annular calcification in the absence of mitral valve disease affect clinical outcomes after transcatheter aortic valve replacement?","volume":"21","author":"Okuno","year":"2020","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.amjcard.2021.06.017","article-title":"Impact of Mitral Annular Calcium and Mitral Stenosis on Outcomes after Transcatheter Aortic Valve Implantation","volume":"155","author":"Mesnier","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1093\/eurheartj\/ehz011","article-title":"Concomitant mitral stenosis may be associated with low flow: What it means and how it potentially impacts on transcatheter aortic valve replacement","volume":"40","author":"Bartel","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.jcin.2018.01.245","article-title":"Prevalence and Outcomes of Mitral Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement: Findings from the Society of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapies Registry","volume":"11","author":"Joseph","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1055\/s-0039-1700966","article-title":"TAVI in Patients with Mitral Annular Calcification and\/or Mitral Stenosis","volume":"69","author":"Schaefer","year":"2021","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1161\/CIRCULATIONAHA.113.001822","article-title":"Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: A multicenter registry","volume":"128","author":"Bedogni","year":"2013","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.1016\/j.athoracsur.2015.05.094","article-title":"Coexisting Mitral Regurgitation Impairs Survival after Transcatheter Aortic Valve Implantation","volume":"100","author":"Takagi","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.jcin.2016.05.025","article-title":"Mitral Regurgitation After Transcatheter Aortic Valve Replacement: Prognosis, Imaging Predictors, and Potential Management","volume":"9","author":"Hernandez","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_55","first-page":"272","article-title":"Outcome and improvement predictors of mitral regurgitation after transcatheter aortic valve implantation","volume":"20","author":"Durst","year":"2011","journal-title":"J. Heart Valve Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e029553","DOI":"10.1161\/JAHA.123.029553","article-title":"Prognostic Impact of Mitral Regurgitation before and after Transcatheter Aortic Valve Replacement in Patients with Severe Low-Flow, Low-Gradient Aortic Stenosis","volume":"12","author":"Ferruzzi","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"102025","DOI":"10.1016\/j.jaccas.2023.102025","article-title":"Concomitant Transapical Aortic\/Mitral Transcatheter Valve Replacement for Severe Aortic Stenosis and Mitral Annular Calcification","volume":"24","author":"Zientara","year":"2023","journal-title":"JACC Case Rep."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e031400","DOI":"10.1161\/JAHA.123.031400","article-title":"Residual Mitral Regurgitation after Transcatheter Aortic Valve Replacement: An Important Target for Intervention","volume":"12","author":"Reed","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/j.athoracsur.2019.04.080","article-title":"Characterizing Risks Associated with Mitral Annular Calcification in Mitral Valve Replacement","volume":"108","author":"Kaneko","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1053\/j.semtcvs.2020.05.021","article-title":"Severe Mitral Annular Calcification and Mitral Valve Surgery: An Algorithmic Approach to Management","volume":"32","author":"Pizano","year":"2020","journal-title":"Semin. Thorac. Cardiovasc. Surg. Winter"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"285","DOI":"10.2459\/JCM.0000000000001242","article-title":"Mitral valve surgery with extensive annular calcification: Review of surgical techniques and postoperative complications","volume":"23","author":"Baudo","year":"2022","journal-title":"J. Cardiovasc. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.jtcvs.2018.05.099","article-title":"Current and evolving strategies in the management of severe mitral annular calcification","volume":"157","author":"Bedeir","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e018514","DOI":"10.1161\/JAHA.120.018514","article-title":"Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review","volume":"10","author":"Alexis","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1001\/jama.2023.7800","article-title":"Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial","volume":"329","author":"Akowuah","year":"2023","journal-title":"JAMA"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Piperata, A., Busuttil, O., D\u2019ostrevy, N., Jansens, J.-L., Taymoor, S., Cuko, B., Modine, T., Pernot, M., and Labrousse, L. (2021). Starting A New Robotic Surgery Program for Mitral Valve Repair. Lessons Learned from the First Nine Months. J. Clin. Med., 10.","DOI":"10.3390\/jcm10225439"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.athoracsur.2018.01.092","article-title":"Good 5-Year Durability of Transapical Beating Heart Off-Pump Mitral Valve Repair with Neochordae","volume":"106","author":"Kiefer","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/j.athoracsur.2008.10.016","article-title":"Transapical transcatheter mitral valve-in-valve implantation in a human","volume":"87","author":"Cheung","year":"2009","journal-title":"Ann. Thorac. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"19","DOI":"10.17925\/HI.2023.17.1.19","article-title":"Transcatheter Mitral Valve Replacement in Patients with Mitral Annular Calcification: A Review","volume":"17","author":"Agrawal","year":"2023","journal-title":"Heart Int."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1016\/j.jcin.2017.08.014","article-title":"Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification","volume":"10","author":"Eleid","year":"2017","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/j.jacc.2018.02.054","article-title":"1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients with Severe Mitral Annular Calcification","volume":"71","author":"Guerrero","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e008425","DOI":"10.1161\/CIRCINTERVENTIONS.119.008425","article-title":"Thirty-Day Outcomes of Transcatheter Mitral Valve Replacement for Degenerated Mitral Bioprostheses (Valve-in-Valve), Failed Surgical Rings (Valve-in-Ring), and Native Valve with Severe Mitral Annular Calcification (Valve-in-Mitral Annular Calcification) in the United States: Data from the Society of Thoracic Surgeons\/American College of Cardiology\/Transcatheter Valve Therapy Registry","volume":"13","author":"Guerrero","year":"2020","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1016\/j.jcin.2021.01.052","article-title":"Prospective Study of TMVR Using Balloon-Expandable Aortic Transcatheter Valves in MAC: MITRAL Trial 1-Year Outcomes","volume":"14","author":"Guerrero","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2521","DOI":"10.1016\/j.jacc.2019.02.076","article-title":"Anterior Leaflet Laceration to Prevent Ventricular Outflow Tract Obstruction during Transcatheter Mitral Valve Replacement","volume":"73","author":"Khan","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ahj.2010.04.009","article-title":"The EVEREST II Trial: Design and rationale for a randomized study of the evalve mitraclip system compared with mitral valve surgery for mitral regurgitation","volume":"160","author":"Mauri","year":"2010","journal-title":"Am. Heart J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.4244\/EIJV12I9A191","article-title":"Mitral annular calcification is not associated with decreased procedural success, durability of repair, or left ventricular remodelling in percutaneous edge-to-edge repair of mitral regurgitation","volume":"12","author":"Cheng","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.4244\/EIJ-D-21-00205","article-title":"Transcatheter edge-to-edge mitral valve repair in patients with mitral annulus calcification","volume":"17","author":"Pascual","year":"2022","journal-title":"EuroIntervention"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"e031118","DOI":"10.1161\/JAHA.123.031118","article-title":"Feasibility and Outcomes of Mitral Transcatheter Edge-To-Edge Repair in Patients with Variable Degrees of Mitral Annular Calcification","volume":"12","author":"Hatab","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Shechter, A., Lee, M., Kaewkes, D., Patel, V., Koren, O., Chakravarty, T., Koseki, K., Nagasaka, T., Skaf, S., and Makar, M. (2024). Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair. Circ. Cardiovasc. Interv., e013424.","DOI":"10.1161\/CIRCINTERVENTIONS.123.013424"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/3\/896\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:54:26Z","timestamp":1760104466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/3\/896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,3]]},"references-count":78,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["jcm13030896"],"URL":"https:\/\/doi.org\/10.3390\/jcm13030896","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,3]]}}}