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Multimodality imaging of mitral annular disjunction
Waldemar Elikowski1, MAłGORZATA Małek-Elikowska2, Teresa Ganowicz-Kaatz3
1Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland.
Polski Merkuriusz Lekarski : Organ Polskiego Towarzystwa Lekarskiego
|November 1, 2020
Summary
Mitral annular disjunction (MAD) is linked to dangerous arrhythmias in some mitral valve prolapse (MVP) patients. MAD causes left ventricular wall and papillary muscle stretch, leading to fibrosis and potential sudden cardiac death (SCD).
Area of Science:
- Cardiology
- Cardiac Imaging
- Pathophysiology
Background:
- Mitral valve prolapse (MVP) affects 2-3% of the population, usually benign.
- Ventricular arrhythmias and sudden cardiac death (SCD) can occur in some MVP patients.
- Mitral annular disjunction (MAD) is identified as a cause of these adverse events.
Purpose of the Study:
- To define Mitral Annular Disjunction (MAD).
- To explain the pathophysiological mechanism linking MAD to malignant arrhythmias.
- To highlight the role of Cardiac Magnetic Resonance (CMR) in diagnosing MAD-related fibrosis.
Main Methods:
- Definition of MAD: separation of mitral valve annulus-left atrial wall and basal posterolateral LV myocardium.
- Pathophysiology: MAD causes stretch of inferior-posterior LV wall and posteromedial papillary muscle.
- Imaging findings: Cardiac Magnetic Resonance (CMR) shows late gadolinium enhancement (LGE) indicating fibrosis.
Main Results:
- MAD leads to fibrosis in the affected cardiac structures.
- Fibrosis serves as a substrate for malignant ventricular arrhythmias.
- Multidetector-row computed tomography (MDCT) is currently underutilized in MAD assessment.
Conclusions:
- MAD is a critical finding in MVP patients at risk for SCD.
- CMR with LGE is valuable for identifying MAD-related myocardial fibrosis.
- Further investigation into MDCT's role in MAD is warranted.
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