Transcatheter mitral valve implantation in severe mitral annular calcification: a case report

Background: Mitral annular calcification (MAC) is characterized by severe calcification of mitral annulus and might be associated with both mitral regurgitation and stenosis. It is technically challenging for both surgical and percutaneous approach and is burdened by high mortality.

Case summary: The present case report describes a complex case of mitral steno-insufficiency (baseline transvalvular gradient = 5 mmHg, effective regurgitant orifice area 0.45 cm², vena contracta 0.8 cm), due to MAC in an 83-year-old lady. In consideration of the clinical context (MAC) and patient's several comorbidities and history of previous surgical interventions, she was deemed not suitable for surgery and a percutaneous treatment was selected (valve-in-MAC). Due to significant paravalvular leak, further implantation of a plug was required.

Conclusion: The MAC represents a clinical and technical challenge for surgery. Transcatheter mitral valve implantation in MAC is a feasible alternative although it is technically challenging and burdened by high mortality. Detailed procedural planning is of utmost importance to achieve successful outcomes.