Bertrand Philippe B, Mihos Christos G, Yucel Evin
Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA.
Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA.
Curr Treat Options Cardiovasc Med. 2019 Mar 30;21(4):19. doi: 10.1007/s11936-019-0723-6.
Mitral annular calcification (MAC) and associated calcific mitral stenosis (MS) are frequent in the aging population, although optimal management remains debated and outcomes are poor. This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options.
Surgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools has proven to be essential. MAC and calcific MS is an increasingly prevalent, challenging issue with poor outcomes. While surgical valve replacement can be performed in patients with acceptable surgical risk, TMVR can be considered for patients at higher risk. Clinical trials are underway to optimize outcomes. Dedicated device designs and techniques to minimize risk of left ventricular outflow tract obstruction, paravalvular leakage, and device embolization are to be awaited.
二尖瓣环钙化（MAC）及相关钙化性二尖瓣狭窄（MS）在老年人群中很常见，尽管最佳治疗方案仍存在争议且预后较差。本文总结了钙化性MS诊断和治疗中的挑战、瓣膜干预的指征、手术相关问题以及新兴的治疗选择。
对于手术风险可接受的有症状患者，外科二尖瓣置换术是首选治疗方法，经导管二尖瓣置换术（TMVR）正在临床试验中作为手术风险过高患者的替代方案进行评估。目前可用的技术存在重大挑战，且治疗效果一直不太理想。事实证明，使用多模态成像工具优化患者选择过程至关重要。MAC和钙化性MS是一个日益普遍且具有挑战性的问题，预后较差。对于手术风险可接受的患者可进行外科瓣膜置换，而对于风险较高的患者可考虑TMVR。目前正在进行临床试验以优化治疗效果。有待出现专门的设备设计和技术，以尽量降低左心室流出道梗阻、瓣周漏和器械栓塞的风险。
