Symptoms of mitral annular calcification

Do you know what mitral annular calcification is? It is very common in elderly women over 70 years old and can cause many types of heart diseases, such as mitral regurgitation and atrial fibrillation. Many patients should have done an electrocardiogram. Mitral annular calcification is a very common sign on the electrocardiogram. Do you know the symptoms of mitral annular calcification? Let's take a look.

The most common site of mitral annular calcification is the posterior ventricular surface, and it is most common in European and American populations. The cause of mitral annular calcification is still not very clear in medicine. You can diagnose this disease in a timely manner by understanding the symptoms of mitral annular calcification.

Clinical manifestations

Determined by the degree of annular calcification. Mild cases have no clinical symptoms; severe cases have thickened and fixed valvular rings that cannot shrink with ventricular contraction, and restricted mitral valve activity, which can cause mitral regurgitation or stenosis. A systolic murmur can be heard at the apex and lower left edge of the sternum, transmitting toward the base of the heart. This disease is often accompanied by degenerative changes of the sinus node and conduction system, resulting in sinus bradycardia, atrioventricular block, atrial fibrillation with a slow ventricular rate, etc. In a small number of patients, embolism occurs in different parts of the body due to the loosening of calcium in the valve ring, the most common of which is cerebral and retinal artery embolism.

treat

Generally, there is no obvious hemodynamic effect and no treatment is required. Patients with symptoms of heart failure should be treated symptomatically. Surgery is feasible if there are hemodynamic changes. The surgical treatments for mitral annular calcification include:

1. Repair methods for annular dilatation

(1) Reed method: Use forceps to grasp the free edge of the anterior leaflet and pull it posteriorly to determine the midpoint A of the base of the anterior leaflet. Draw a vertical line from the midpoint of the anterior leaflet to the posterior leaflet, dividing the mitral valve orifice into two symmetrical halves, and find the midpoint B of the posterior leaflet ring. At the anterior external corner and posterior internal corner of the mitral valve, a mattress suture is made through the fibrous triangle at the base of the anterior leaflet and the valve ring of the posterior leaflet, respectively. The two mattress sutures are 2 cm away from the midpoint on the anterior leaflet side and 1 cm away from the midpoint of the posterior leaflet on the posterior leaflet side. After tightening the ligature, the flap should be able to loosely accommodate the index and middle fingers. ②Commissural folding and ring contraction technique: Mattress suture is performed at the commissural area. The distance between the sutures on the posterior leaflet side and the valve ring is wider than that on the anterior leaflet side, and the needle is inserted into the valve ring. This method is often used to correct partial regurgitation. ③ The posterior valve ring half purse-string reduction technique makes two half purse-string sutures on the posterior leaflet valve ring and adds gaskets at both ends. The sutures are contracted so that the flap can loosely accommodate the index and middle fingers and then ligated.

2. Repair of annular calcification

Calcifications must be carefully removed to prevent atrioventricular rupture, especially those deep in the ventricular wall. Myxomatous mitral annular calcification is a manifestation of degenerative changes including the cardiac fiber support caused by abnormal transvalvular pressure caused by mitral valve disease. Typical degenerative annular calcification is mostly in the posterior annulus, but sometimes also involves the posterior ventricular wall. Annular calcification is often accompanied by chordae tendineae elongation and posterior leaflet insufficiency. Korn et al. distinguished myxoid degeneration from rheumatic lesions because myxoid calcifications do not involve the chordae tendineae and do not thicken the leaflets. Therefore, valves with myxomatous changes are easier to repair than valves with rheumatic lesions, and the long-term results after repair are also better.

Everyone should be aware of the symptoms of mitral annular calcification. How does such an age-related disease occur? Everyone should know some methods to prevent such diseases. Especially in the elderly stage, everyone should pay more attention to their bodies and be able to control their blood pressure and blood lipids in time to avoid the occurrence of rheumatic diseases.