Mitral annular disjunction versus myocardial Ischemia in coronary artery anomalies

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Congenital Heart Disease

Background:

• Mitral annular disjunction (MAD) and anomalous aortic origin of a coronary artery (AAOCA) are linked to ventricular arrhythmias (VA).
• Limited data exist on the co-occurrence of MAD and AAOCA and their combined impact on VA.
• Understanding this association is crucial for diagnosing and managing complex cardiac conditions.

Purpose of the Study:

• To investigate the co-occurrence of AAOCA and MAD in patients presenting with ventricular arrhythmia.
• To highlight the clinical significance of MAD as a potential arrhythmogenic substrate, especially when ischemia is ruled out.

Main Methods:

• Case report presentation of two patients with confirmed AAOCA and MAD.
• Clinical evaluation including electrophysiological studies and imaging modalities.
• Review of existing literature on MAD, AAOCA, and ventricular arrhythmias.

Main Results:

• Both presented patients exhibited ventricular arrhythmias.
• The co-occurrence of AAOCA and MAD was identified as a potential contributing factor to their arrhythmias.
• Diagnostic workup ruled out significant ischemic heart disease as the primary cause.

Conclusions:

• Mitral annular disjunction should be considered a significant potential cause of ventricular arrhythmia.
• In cases of unexplained ventricular arrhythmia, particularly when stress tests do not reveal ischemia, evaluating for MAD is recommended.
• The combination of AAOCA and MAD may represent a specific phenotype predisposing to ventricular arrhythmias.