Randy Martin, MD, and Ahmed El-Eshmawi, MD, discuss the increasingly common syndrome of mitral annular calcification (MAC). They highlight the incidence, etiology (elderly, CKD, women, and Barlow’s mitral valve disease,) and critical role imaging plays in diagnosis and treatment. Dr. El-Eshmawi shares three cases, including intraoperative video, which highlight techniques for treatment. He also discusses the algorithm that The Mount Sinai Hospital has developed over a 10-year period of proper treatment in over 70 patients. This algorithm will help you understanding how to evaluate and treat your patients, whether by an interventional approach, surgery, or a combination.