Cintosun Amber, Belzile David, Sooriyakanthan Maala, Orchanian-Cheff Ani, Tsang Wendy
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2024 Sep 17;6(12):1538-1548. doi: 10.1016/j.cjco.2024.09.001. eCollection 2024 Dec.
Mitral annular calcification (MAC) is a common chronic degenerative process of the mitral valve. Thrombus formation on MAC is a rare complication that likely contributes to the increased risk of thromboembolic events. Outcomes and management strategies for this condition are unknown. The aim of this study was to perform a systematic review to describe the management and outcomes of patients who have thrombus on MAC.
The MEDLINE, Embase, and Cochrane databases were searched. Patients with a prior mitral valve intervention or prosthesis were excluded. The primary outcomes were treatment, mortality, and thromboembolic events.
Fifteen studies, with a total of 22 cases (patients aged 69.1 ± 14.8 years; n = 18 [82%] female) were included. Most patients presented with stroke or a transient ischemic event (n = 15; 68%) or myocardial infarction (n = 4; 18%). All patients were diagnosed with either transthoracic (n = 18; 82%) or transesophageal (n = 4; 18%) echocardiography. Seventeen patients (77%) were treated with anticoagulation therapy alone, and 5 (23%) required surgery. The most common surgical indication was prevention of recurrent embolization (n = 3; 14%). No mortality was reported. Six patients (27%) had thromboembolic events after diagnosis. For those treated with anticoagulation therapy alone, 5 (23%) had persistent thrombus with or without embolization.
In this systematic review, patients with MAC who present with a thromboembolic event require careful echocardiographic assessment of the MAC, to exclude the presence of thrombus. Although most patients can be managed with anticoagulation therapy alone, a significant number will require surgery. Persistent thrombus, despite anticoagulation therapy, and recurrent embolization are common. Larger studies are needed to elucidate what constitutes the optimal long-term care for these patients.
二尖瓣环钙化（MAC）是二尖瓣常见的慢性退行性病变过程。MAC上形成血栓是一种罕见的并发症，可能会增加血栓栓塞事件的风险。这种情况的治疗结果和管理策略尚不清楚。本研究的目的是进行一项系统评价，以描述MAC上有血栓的患者的管理和治疗结果。
检索MEDLINE、Embase和Cochrane数据库。排除既往有二尖瓣干预或植入人工瓣膜的患者。主要结局指标为治疗、死亡率和血栓栓塞事件。
纳入15项研究，共22例患者（患者年龄69.1±14.8岁；n = 18 [82%]为女性）。大多数患者表现为中风或短暂性脑缺血发作（n = 15；68%）或心肌梗死（n = 4；18%）。所有患者均通过经胸（n = 18；82%）或经食管（n = 4；18%）超声心动图诊断。17例患者（77%）仅接受抗凝治疗，5例（23%）需要手术治疗。最常见的手术指征是预防复发性栓塞（n = 3；14%）。未报告死亡病例。6例患者（27%）在诊断后发生血栓栓塞事件。仅接受抗凝治疗的患者中，5例（23%）有持续性血栓，伴或不伴有栓塞。
在本系统评价中，出现血栓栓塞事件的MAC患者需要通过超声心动图仔细评估MAC，以排除血栓的存在。虽然大多数患者仅通过抗凝治疗即可管理，但仍有相当数量的患者需要手术治疗。尽管进行了抗凝治疗，但持续性血栓和复发性栓塞仍很常见。需要更大规模的研究来阐明这些患者的最佳长期护理方案。
