Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.
University of Pernambuco - UPE, Recife, Brazil.
Curr Atheroscler Rep. 2020 Feb 7;22(2):9. doi: 10.1007/s11883-020-0825-3.
This review summarizes the pathophysiology of mitral annular calcification (MAC) with recent findings and current strategies for diagnosis and treatment.
Major factors in MAC development seem to be shear stress of the flow past the mitral valve, local inflammation, and dysregulation in regulators of mineral metabolism. MAC itself poses daunting technical challenges. Implanting a valve on top of the calcium bar might lead to paravalvular leak (PVL) that is less likely to heal. Annular decalcification allows for better valve seating and potentially better healing and less PVL. This, however, comes with the risk for catastrophic atrioventricular groove disruption. MAC can be sharply dissected with the scalpel; the annulus can be reconstructed with the autologous pericardium. Transcatheter mitral valve replacement is a promising approach in the treatment of patients who are deemed high-risk surgical candidates with severe MAC. MAC is a multifactorial disease that has some commonalities with atherosclerosis, mainly regarding lipid accumulation and calcium deposition. It is of great clinical importance, being a risk marker of cardiovascular events (including sudden death) and, with its progression, can have a negative impact on patients' lives.
本文总结了二尖瓣环钙化（MAC）的病理生理学，重点介绍了最新发现和目前的诊断及治疗策略。
MAC 发展的主要因素似乎是流经二尖瓣的血流剪切力、局部炎症和矿物质代谢调节剂的失调。MAC 本身带来了严峻的技术挑战。在钙条上植入瓣膜可能会导致瓣周漏（PVL），且不太可能愈合。环形去钙化有利于更好地定位瓣环，从而可能实现更好的愈合和更少的 PVL，但这会增加房室沟灾难性撕裂的风险。MAC 可以用手术刀进行锐性分离，也可以用自体心包进行重建。经导管二尖瓣置换术是一种有前途的治疗方法，适用于被认为是高危手术患者的严重 MAC 患者。MAC 是一种多因素疾病，与动脉粥样硬化有一些共同之处，主要涉及脂质积聚和钙沉积。它具有重要的临床意义，是心血管事件（包括猝死）的风险标志物，随着疾病进展，会对患者的生活产生负面影响。
