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Review
. 2024 Oct;17(10):1229-1245.
doi: 10.1016/j.jcmg.2024.03.006. Epub 2024 May 1.

Mitral Annular Disjunction in the Context of Mitral Valve Prolapse: Identifying the At-Risk Patient

Pieter Van der Bijl  1 , Jan Stassen  2 , Kristina H Haugaa  3 , Benjamin Essayagh  4 , Cristina Basso  5 , Gaetano Thiene  5 , Francesco F Faletra  6 , Thor Edvardsen  7 , Maurice Enriquez-Sarano  8 , Petros Nihoyannopoulos  9 , Nina Ajmone Marsan  1 , Yellapragada S Chandrashekhar  10 , Jeroen J Bax  11
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Free article
Review

Mitral Annular Disjunction in the Context of Mitral Valve Prolapse: Identifying the At-Risk Patient

Pieter Van der Bijl et al. JACC Cardiovasc Imaging. 2024 Oct.
Free article

Abstract

Mitral annular disjunction (MAD), a separation between the left atrium/mitral valve annulus and the left ventricular myocardium, is frequently seen in patients with arrhythmic mitral valve prolapse. Although an association exists between MAD and ventricular arrhythmias, little is known regarding the identification of individuals at high risk. Multimodality imaging including echocardiography, computed tomography, cardiac magnetic resonance, and positron emission tomography can play an important role in both the diagnosis and risk stratification of MAD. Due to a paucity of data, clinical decision making in a patient with MAD is challenging and remains largely empirical. Although MAD itself can be corrected surgically, the prevention and treatment of associated arrhythmias may require medical therapy, catheter ablation, and an implantable cardioverter-defibrillator. Prospective data are required to define the role of implantable cardioverter-defibrillators, targeted catheter ablation, and surgical correction in selected, at-risk patients.

Keywords: arrhythmias; disjunction; imaging; mitral annular; mitral valve prolapse.

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Conflict of interest statement

Funding Support and Author Disclosures The Department of Cardiology of Leiden University Medical Center has received research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Dr Stassen has received grants from the European Society of Cardiology (Training Grant App000064741). Dr Haugaa has received grants from the Norwegian Research Council (ProCardio #309762, #288438, #298736). Dr Faletra has received speaker fees from Philips Healthcare. Dr Enriquez-Sarano has received consulting fees from Artivion, ChemImage, Edwards Lifesciences, and HighLife. Dr Marsan has received speaker fees from Abbott Vascular and GE Healthcare. Dr Bax has received speaker fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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