Mitral annular disjunction: Beyond mitral valve prolapse

Area of Science:

• Cardiology
• Cardiac Imaging
• Electrophysiology

Background:

• Mitral annular disjunction (MAD) is an echocardiographic finding frequently associated with mitral valve prolapse.
• MAD is an independent risk marker for ventricular arrhythmias and sudden cardiac death.
• Current management and risk stratification for patients with MAD are not systematized.

Approach:

• Presents two clinical cases of MAD associated with mitral valve prolapse and ventricular arrhythmias.
• Details a case of sustained monomorphic ventricular tachycardia in a patient with prior mitral valve surgery and MAD.
• Focuses on risk stratification approaches for a young woman with palpitations, premature ventricular contractions, and MAD.

Key Points:

• Mitral annular disjunction is often underrecognized despite being identifiable on echocardiography.
• The association between MAD, mitral valve prolapse, and serious ventricular arrhythmias is significant.
• Systematic approaches to risk stratification and management in MAD patients are needed.

Conclusions:

• MAD, particularly when associated with mitral valve prolapse, represents a significant arrhythmic risk.
• Further research is warranted to establish standardized risk stratification and management protocols for MAD.
• Early identification and appropriate evaluation of MAD are crucial for patient outcomes.