Mitral valve training › Guides › Mitral annular calcification
Mitral annular calcification (MAC) on echocardiography
What to look for: Bright calcium behind the posterior leaflet base.
Watch it in the simulator →Practise random casesCarpentier Type I: normal motion. A dilated annulus, a hole or a cleft. Jet: central, or through the leaflet.
Carpentier Type IIIa: restricted in systole and diastole. Thick, stiff leaflets: rheumatic, with fused commissures, or calcific. Jet: often posterior. The classification
Carpentier Type IIIa: restricted in systole and diastole. Thick, stiff leaflets: rheumatic, with fused commissures, or calcific. Jet: often posterior. The classification
Key findings
- Mitral annular calcification: dense, bright calcium in the posterior annulus, often with acoustic shadowing; it is common with age and chronic kidney disease.
- It causes MR by stiffening the annulus (type I), and stenosis when the calcium extends into the leaflet bases and restricts them, without commissural fusion.
- In calcific stenosis planimetry and the pressure half-time are unreliable: grade it by the mean gradient at a stated heart rate and, where possible, the continuity equation.
Grading the regurgitation (primary MR)
- Severe: vena contracta ≥7 mm, EROA ≥0.40 cm², regurgitant volume ≥60 ml, regurgitant fraction ≥50%. Mild: vena contracta <3 mm, EROA <0.20 cm², regurgitant volume <30 ml.
- Specific signs of severe MR: a flail leaflet or ruptured papillary muscle, a large flow convergence, and systolic flow reversal in the pulmonary veins; a dense, triangular CW signal and an E-wave-dominant inflow support it.
- Integrate several signs: no single measurement grades MR on its own.
Pitfalls
- The calcium shadows the LA in apical views and can hide a jet: use several views, and TOE when it matters.
In the simulator every case varies the anatomy, the jets and the measurements: watch the lesion in Learn, then grade new cases in Practice and compare your answer with the exact one.
Related
Rheumatic mitral disease · Atrial functional MR
Educational simulation to use under the supervision of a clinical tutor — not for clinical use.