Multimodality imaging of mitral annular disjunction

Abstract

Mitral valve prolapse (MVP) is diagnosed by auscultation and echocardiography in about 2-3% of the general population and takes rather a benign course. However, in some patients, ventricular arrhythmia and sudden cardiac death (SCD) occur, which is linked to mitral annular disjunction (MAD). MAD is defined as distinct separation of the mitral valve annulus-left atrial wall continuum and the basal region of the posterolateral left ventricular (LV) myocardium. MAD results in disturbed inferior-posterior LV wall and posteromedial papillary muscle stretch giving rise to local fibrosis presenting in cardiac magnetic resonance (CMR) as late gadolinium enhancement (LGE) and posing a substrate for malignant arrhythmia. Multidetector-row computed tomography (MDCT) in MAD patients is still rarely used.

A case report: Mitral valve prolapse (MVP) is diagnosed by auscultation and echocardiography in about 2-3% of the general population and takes rather a benign course. However, in some patients, ventricular arrhythmia and sudden cardiac death (SCD) occur, which is linked to mitral annular disjunction (MAD). MAD is defined as distinct separation of the mitral valve annulus-left atrial wall continuum and the basal region of the posterolateral left ventricular (LV) myocardium. MAD results in disturbed inferior-posterior LV wall and posteromedial papillary muscle stretch giving rise to local fibrosis presenting in cardiac magnetic resonance (CMR) as late gadolinium enhancement (LGE) and posing a substrate for malignant arrhythmia. Multidetector-row computed tomography (MDCT) in MAD patients is still rarely used.

Keywords: cardiac magnetic resonance; echocardiography; malignant arrhythmia; mitral annular disjunction; mitral valve prolapse; multidetector-row computed tomography; sudden cardiac death.