Mitral Annular Calcification (MAC) is a complex and increasingly common syndrome. In this discussion we review Mount Sinai’s proven algorithm for determining the best treatment for MAC, as well as imaging and intraoperative videos that highlight:

• The incidence and etiology of MAC, especially for those at high risk: the elderly, patients with CKD, women, and patients with Barlow’s mitral valve disease
• The critical role of CT imaging to quantify the extent of mitral annular and valvular calcification, and its location in the annulus, leaflets or ventricles.
• Key surgical considerations, including:,
  • Periannular suture technique
  • Management of the anterior mitral valve leaflet to reduce the risk of left ventricular outflow tract obstruction
  • Proper selection of mitral valve prostheses
• Why referring patients with complex mitral disease to designated mitral valve reference centers improves clinical outcomes.

Ahmed El-Eshmawi, MD 
Clinical Director, Mitral Valve Repair Reference Center at The Mount Sinai Hospital
Associate Professor, Department of Cardiovascular Surgery
Icahn School of Medicine at Mount Sinai 

Randolph P. Martin, MD
Clinical Professor, Department of Cardiovascular Surgery
Icahn School of Medicine at Mount Sinai