Quantifying mitral stenosis in MAC: are we doing it right?

Abstract Introduction and objectives Degenerative mitral valve disease due to mitral annular calcification (MAC) is a growing problem that represents a therapeutic challenge. Unlike regurgitation, quantification of mitral stenosis (MS) severity is not well established in this condition. To date, the usefulness of conventional echocardiographic parameters in this subgroup has not been demonstrated, as they were developed in the context of the rheumatic etiology. Quantifying their severity is essential for choosing different therapeutic approaches. We evaluated the usefulness of different echocardiographic methods for assessing MS severity in the context of MAC compared to the established gold standard. Furthermore, MS was correlated with the degree of MAC severity by CT. Methods We retrospectively evaluated patients with MAC who underwent 3D TEE and CT as part of their valvular disease evaluation between 2019 and 2022. MVA was determined by 3D transesophageal planimetry. Severe MS was considered an MVA