Severe Mitral Annular Calcification: Multimodality Imaging for Therapeutic Strategies and Interventions.

Mitral annular calcification (MAC) is a chronic degenerative process associated with advanced age and conditions predisposing to left ventricular hypertrophy. Assessment of mitral valve disease in patients with severe MAC can be a challenge. When severe MAC results in mitral stenosis or regurgitation, multimodality imaging with 2-dimensional, 3-dimensional, and Doppler echocardiography and cardiac computed tomography angiography can delineate the severity and pathoanatomic features to help guide therapeutic strategies. New approaches using computer-assisted simulation of transcatheter valves and novel percutaneous and surgical techniques are being used to devise effective alternative strategies to conventional mitral valve replacement in this high-risk group of patients.