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Mitral annular disjunction in surgical mitral valve prolapse: prevalence, characteristics and outcomes

Rhys Gray1, Praveen Indraratna2, Gregory Cranney2

  • 1Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia. rhys_gray@hotmail.com.

Echo Research and Practice
|November 8, 2023
PubMed
Abstract

Insights

Mitral annular disjunction (MAD) is common in mitral valve prolapse (MVP) surgery patients, affecting nearly one-third. While MAD doesn't hinder repair, post-surgery arrhythmia risk is higher, warranting further monitoring research.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Imaging

Background:

  • Limited data exists on outcomes for patients with mitral valve prolapse (MVP) and mitral annular disjunction (MAD) post-mitral surgery.
  • Unanswered questions include MAD persistence, impact on valve repair, and arrhythmia incidence after surgery.

Purpose of the Study:

  • To investigate the prevalence, imaging characteristics, and clinical associations of MAD in MVP patients undergoing mitral valve surgery.
  • To evaluate post-surgical outcomes, including MAD persistence, arrhythmic events, and mortality.

Main Methods:

  • Retrospective analysis of 111 consecutive patients undergoing mitral valve surgery for MVP.
  • Assessment of MAD prevalence, patient demographics, comorbidities, and surgical outcomes.
  • Follow-up over 3.91 years to evaluate post-operative events.

Main Results:

  • MAD was present in 28.8% of patients, who were younger, more likely female, and had specific leaflet and prolapse characteristics.
  • Mitral valve repair was successful in 90.6% of MAD-positive patients, with no post-surgical MAD persistence.
  • Post-operative ventricular arrhythmia was higher in the MAD group (28.13% vs 11.69%), but mortality and re-admission rates were similar.

Conclusions:

  • Mitral annular disjunction (MAD) is a frequent finding in mitral valve prolapse (MVP) surgery.
  • MAD does not impede mitral valve surgical repair or replacement and does not significantly affect post-surgical outcomes.
  • Further research is needed to determine if MVP patients with MAD require post-surgical arrhythmia monitoring.
Keywords:
MitralMitral annular disjunctionMitral valve prolapseMitral valve repairValve replacement

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