The analysis of mitral annular disjunction detected by echocardiography and comparison with previously reported pathological data

Konda, Toshiko; Tani, Tohru; Suganuma, Naoko; Nakamura, Hitomi; Sumida, Toshiaki; Fujii, Yoko; Kawai, Junichi; Kitai, Takeshi; Kim, Kitae; Kaji, Shuichiro; Furukawa, Yutaka

doi:10.1007/s12574-017-0349-1

Cited by 61 publications

(52 citation statements)

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“…Essayah et al reported that myxomatous mitral valve disease was a strongly associated with MAD (HR 5.04 95% CI 1.66–15.31), and other significant variables included mitral regurgitation severity (HR 3.12 95% CI 1.002–9.806) and mitral annulus diameter end‐systolic 2‐chamber length (HR 1.17 95% CI 1.05–1.30) . Konda et al reported that mitral valve prolapse was associated with MAD (OR 3.65 95% CI 1.70–7.83) . In the study by Torras 2018, all patients with MAD had bi‐leaflet prolapse and all patients with myxomatous mitral valve prolapse and sudden death had larger MAD distance (10.3 ± 1.5 vs 6.9 ± 1.7 mm) .…”

Section: Resultsmentioning

confidence: 61%

“…11 Konda et al reported that mitral valve prolapse was associated with MAD (OR 3.65 95% CI 1.70-7.83). 7 In the study by Torras 2018, all patients with MAD had bi-leaflet prolapse and all patients with myxomatous mitral valve prolapse and sudden death had larger MAD distance (10.3 ± 1.5 vs 6.9 ± 1.7 mm). 18 The observation about sudden cardiac death with longer MAD was also reported by Parazzollo Marra et al 5…”

Section: Re Sultsmentioning

confidence: 93%

“…A total of 19 studies were included in the review ( Figure 3). 1,2,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] These studies included 14 retrospective cohort studies, 2 matched case-control studies, 1 cross-sectional study and 2 case reports ( Table 1). The studies were conducted between 1995 and 2018.…”

Section: Re Sultsmentioning

confidence: 99%

“…At that time, MAD was not attributed to clinically adverse outcomes and as such it received little attention. In more recent years, there has been an increasing number of studies examining the different aspects of MAD, with a general theme that MAD maybe of more clinical significance than previously thought. In particular, MAD leads to hypermobility and myxomatous degeneration of the mitral valve leaflets and there is growing evidence that MAD may be associated with ventricular arrhythmias and sudden cardiac death …”

Section: Introductionmentioning

confidence: 99%

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Mitral annular disjunction: A systematic review of the literature

et al. 2019

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Background Mitral annular disjunction (MAD) is a structural abnormality where there is a separation between the mitral valve annulus and the left atrial wall which is not well understood. Methods We conducted a systematic review to evaluate the prevalence of MAD, factors associated with MAD and clinical outcomes among patients with MAD. Results A total of 19 studies were included in this review, and the number of noncase report studies had between 23 and 1439 patients. The pooled rate of MAD in studies of myxomatous mitral valve patients was 66/130 (50.8%, 3 studies), and among patients with mitral valve prolapse was 95/291 (32.6%, 3 studies). One study suggests that 78% of patients with MAD had mitral valve prolapse, and another suggested it was strongly associated with myxomatous mitral valve disease (HR 5.04 95% CI 1.66–15.31). In terms of clinical significance, it has been reported that MAD with disjunction > 8.5 mm was associated with nonsustained ventricular tachycardia (OR 10 95% CI 1.28–78.1). There is also evidence that gadolinium enhancement in papillary muscle (OR 4.09 95% CI 1.28–13.05) and longitudinal MAD distance in posterolateral wall (OR 1.16 95% CI 1.02–1.33) was predictive of ventricular arrhythmia and late gadolinium enhancement in anterolateral papillary muscle was strongly associated with serious arrhythmic event (OR 7.35 95% CI 1.15–47.02). Conclusions Mitral annular disjunction appears to be common in myxomatous mitral valve disease and mitral valve prolapse which can be detected on cardiac imaging and may be important because of its association with ventricular arrhythmias and sudden cardiac death.

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Section: Resultsmentioning

confidence: 61%

Section: Re Sultsmentioning

confidence: 93%

Section: Re Sultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mitral annular disjunction: A systematic review of the literature

et al. 2019

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“…Передняя часть фиброзного кольца остается практически неподвижной, в то время как изменение размера атриовентрикулярного отверстия происходит за счет подвижности задней части. Митральное кольцо участвует в сокращении сердца, смещаясь вертикально к предсердию и уменьшаясь в размере во время систолы, к верхушке желудочка -во время диастолы [10,11].…”

Section: нормальная анатомия мкunclassified

Clinical and morphological features of malformations of the mitral valve complex

Trysvetava

Yudina

2020

Russ J Cardiol

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The mitral valve complex is a multicomponent anatomically and functionally coordinated formation, ensuring the activity of the left ventricle and, in general, the heart. Congenital disorders of the structure, quantity, and form of the mitral complex components can be asymptomatic or cause hemodynamic changes that require surgery. Often, clinical signs of mitral complex abnormalities are manifested as mitral stenosis, regurgitation or its combination and contribute to misdiagnosis. To identify the morphological features of abnormalities by echocardiography, it is necessary to know the possible structure aberrations. The article describes the normal anatomy of the mitral valve complex and abnormalities of the fibrous ring, valve leaflets, papillary muscles and chordae tendineae.

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Association of Mitral Annular Disjunction With Cardiovascular Outcomes Among Patients With Marfan Syndrome

et al. 2021

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IMPORTANCE Mitral annular disjunction (MAD) has received particular interest in patients with mitral valve prolapse, ventricular tachycardia, and sudden cardiac death. The clinical significance of MAD for patients with Marfan syndrome (MFS) remains largely unexplored. OBJECTIVE To define the prevalence of MAD and examine its association with cardiovascular outcomes and arrhythmia among patients with MFS. DESIGN, SETTING, AND PARTICIPANTS This retrospective, single-center cohort study included 142 patients with a diagnosis of MFS based on the revised Ghent criteria and a confirmed (likely) pathogenic variant in the FBN1 gene who underwent regular follow-up between January 1, 2004, and December 31, 2019. MAIN OUTCOMES AND MEASURES The presence of MAD was assessed by echocardiography, and the extent of MAD was categorized in tertiles. Patients also underwent resting electrocardiography and 24-hour Holter monitoring. Outcomes included aortic events (aortic dissection or prophylactic aortic surgery), arrhythmic events (defined as sustained ventricular tachycardia or sudden cardiac death), and mitral valve surgery. RESULTS A total of 142 patients (72 female patients [51%]; median age at first examination, 25 years [range, 2-64 years]) were evaluated. Forty-eight patients (34%) had MAD. Patients with MAD had larger aortic root z scores than patients without MAD (4.1 [interquartile range, 2.8-5.7] vs 3.0 [interquartile range, 1.8-4.0]; P < .001) and more often had mitral valve prolapse (34 of 48 [71%] vs 14 of 94 [15%]; P < .001), ventricular ectopy (14 of 33 [42%] vs 15 of 70 [21%]; P = .03), and nonsustained ventricular tachycardia (13 of 33 [39%] vs 12 of 70 [17%]; P = .01). During follow-up, aortic events occurred at similar rates among patients with vs without MAD (15 of 43 [35%] vs 21 of 84 [25%]; P = .24), but patients in the upper MAD tertile (>10 mm) showed a higher occurrence of aortic events compared with patients with MAD of 10 mm or smaller (9 of 15 [60%] vs 6 of 28 [21%]; P = .01). Patients with arrhythmic events (n = 5) and patients requiring mitral valve surgery (n = 7) were observed exclusively in the group displaying MAD.CONCLUSIONS AND RELEVANCE This study suggests that MAD among patients with MFS is associated with the occurrence of arrhythmic events, a higher need for mitral valve intervention, and, among patients with extensive MAD, more aortic events. Cardiac imaging for patients with MFS should consider the assessment of MAD as a potential marker for adverse outcomes.

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The analysis of mitral annular disjunction detected by echocardiography and comparison with previously reported pathological data

Cited by 61 publications

References 13 publications

Mitral annular disjunction: A systematic review of the literature

Mitral annular disjunction: A systematic review of the literature

Clinical and morphological features of malformations of the mitral valve complex

Association of Mitral Annular Disjunction With Cardiovascular Outcomes Among Patients With Marfan Syndrome

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