A tale of two MADs: a case series

Area of Science:

• Cardiology
• Cardiac Imaging
• Electrophysiology

Background:

• Mitral annular disjunction (MAD) is an echocardiographic finding characterized by systolic separation of the mitral annulus.
• Historically linked to sudden cardiac death in mitral valve prolapse, its significance remains debated, with some viewing it as a normal variant.

Observation:

• Two cases illustrate the varied clinical presentations of MAD.
• A young woman with syncope had microscopic MAD but a coronary anomaly was the cause of her symptoms.
• A young man with aborted sudden cardiac death had macroscopic MAD with mitral valve prolapse and high-risk features.

Findings:

• MAD's clinical significance is context-dependent and requires thorough patient evaluation.
• Microscopic MAD may not be directly causative of symptoms, unlike coronary anomalies.
• Macroscopic MAD in mitral valve prolapse can be associated with significant arrhythmic risk.

Implications:

• Accurate diagnosis of MAD requires integrating echocardiographic findings with clinical presentation and other imaging modalities.
• Comprehensive assessment should include evaluating MAD extent, arrhythmias, and associated cardiac remodeling.
• Distinguishing between normal variants and pathological MAD is essential for appropriate patient management and risk stratification.