skip to main content

Mitral Stenosis Due to MAC — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardValvular Heart DiseaseMitral Stenosis Due to MACEECC

A 75-year-old woman with severe mitral annular calcification (MAC) has severe mitral stenosis (MVA 1.2 cm², mean gradient 10 mmHg). She is symptomatic (NYHA class III) despite diuretics and rate control. The Heart Team considers her too high risk for conventional mitral valve replacement. What emerging transcatheter option may be considered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Transcatheter mitral valve replacement (TMVR) in MAC, acknowledging it remains an evolving procedure performed in specialised centres with limited long-term data

Severe mitral stenosis due to MAC represents a challenging clinical scenario. Unlike rheumatic MS, PMBV is contraindicated in MAC-related MS because the pathology is annular (not commissural), and balloon dilation risks catastrophic annular rupture. TEER does not address stenosis. Transcatheter mitral valve replacement (TMVR) in MAC is an emerging procedure (e.g. using balloon-expandable valves off-label or dedicated TMVR systems), but remains high-risk with limited evidence. It should only be performed at specialised centres within clinical trials or compassionate use programs. The 2025 ESC VHD Guidelines acknowledge TMVR as an evolving option for inoperable patients.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease