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Case Reports
. 2024 Jul 7;16(7):e64020.
doi: 10.7759/cureus.64020. eCollection 2024 Jul.

Mitral Valve Prolapse With Mitral Annular Disjunction Causing Ventricular Tachycardia During a Stress Test: A Case Report

Alfredo E Palomino Abella  1 , Omar M Masarweh  1 , Murali Iyyani  2 , Volodymyr Oliynyk  2 , Nicole Gill-Duncan  3
Affiliations
Case Reports

Mitral Valve Prolapse With Mitral Annular Disjunction Causing Ventricular Tachycardia During a Stress Test: A Case Report

Alfredo E Palomino Abella et al. Cureus. .

Abstract

Mitral valve prolapse (MVP) is a relatively common valvular disorder characterized by displacement of one or both mitral valve leaflets into the left atrium (LA) during systole. Mitral annular disjunction (MAD) is an associated abnormality where a portion of the mitral valve annulus attaches superiorly in the left atrial wall. Although MVP is often considered benign, it can rarely lead to serious complications such as ventricular arrhythmias, especially when MAD is present. Herein, we present a case of a 63-year-old male with MVP and MAD who experienced sustained ventricular tachycardia (VT) during cardiac stress testing. This case underscores the importance of recognizing MVP with MAD as a potential substrate for ventricular arrhythmias, notably under heightened physiological or induced periods of stress.

Keywords: cardiac mri; cardiac stress test; mitral annular disjunction; mitral valve prolapse; ventricular tachycardia (vt).

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Hospital Corporation of America (HCA) and the University of Central Florida (UCF) issued approval MS3293. This was reviewed by the HCA hospital research advisory committee, and all appropriate IRB forms were signed. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Baseline EKG prior to the stress test
Figure 2
Figure 2. EKG during the stress test showing a wide complex tachycardia
Figure 3
Figure 3. (A) Transthoracic echocardiogram in apical view showing notable MVP with a (B) posteriorly directed jet of mild mitral valve insufficiency with Doppler
MVP: mitral valve prolapse
Figure 4
Figure 4. Angiography showing normal left ventricular end-diastolic pressure, no aortic stenosis, mild luminal irregularities, and no significant disease
(A) No stenosis in the LM, LAD, or LCx. (B) No stenosis in the RCA. LM: left main, LAD: left anterior descending, LCx: left circumflex, RCA: right coronary artery
Figure 5
Figure 5. Normal LV/RV cavity size/thickness with LVEF of 58% and RVEF of 59% (arrow indicating the LV)
LV: left ventricle, RV: right ventricle, LVEF: left ventricular ejection fraction, RVEF: right ventricular ejection fraction
Figure 6
Figure 6. Cardiac MRI with an arrow indicating mild mitral valve regurgitation with posteriorly directed jet
The regurgitant volume is 17 mL. The regurgitant fraction is 15%. MRI: magnetic resonance imaging
Figure 7
Figure 7. Cardiac MRI with an arrow indicating mild thickening and mild prolapse of the anterior mitral valve leaflet (predominantly A2 scallop)
MRI: magnetic resonance imaging
Figure 8
Figure 8. Cardiac MRI with an arrow indicating mild mitral annular disjunction (6.6 mm)
MRI: magnetic resonance imaging
Figure 9
Figure 9. Mid-wall late gadolinium enhancement involving the base to the mid-inferolateral region as typically seen associated with mitral annular disjunction (arrow)
(A) Short-axis view. (B) Long-axis view.
See this image and copyright information in PMC

References

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