Port-Access Robotic Repair of Barlow Mitral Annular Disjunction and Severe Mitral Valve Regurgitation

Mitral annular disjunction (MAD) is associated with malignant ventricular arrhythmias and progressive mitral regurgitation. We describe a 35-year-old man with a history of sudden cardiac death who presented with palpitations and recurrent ventricular arrhythmias. Remote transthoracic echocardiography showed no structural abnormality, with repeated transthoracic echocardiography demonstrating only mild mitral regurgitation. During this admission, transesophageal echocardiography revealed severe mitral regurgitation from Barlow disease with profound MAD. Port-access robotic mitral valve repair eliminated mitral regurgitation and corrected MAD. This case underscores that ventricular arrhythmias may precede valve disease, warranting high suspicion for MAD in young patients with arrhythmias and mild mitral regurgitation.