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https://doi.org/10.15836/ccar2023.173

Mitral annular disjunction and cardiac magnetic resonance

Vesna Pehar Pejčinović orcid id orcid.org/0000-0002-8921-7999 ; Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, Opatija, Croatia
Iva Uravić Bursać orcid id orcid.org/0000-0002-1050-0135 ; Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, Opatija, Croatia
Dijana Travica Samsa orcid id orcid.org/0000-0001-6238-3738 ; Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, Opatija, Croatia
Marijana Rakić ; Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, Opatija, Croatia
Damir Raljević orcid id orcid.org/0000-0001-9743-9201 ; Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, Opatija, Croatia
Viktor Peršić orcid id orcid.org/0000-0003-4473-5431 ; Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism “Thalassotherapia-Opatija”, Opatija, Croatia


Puni tekst: engleski pdf 141 Kb

verzije

str. 173-173

preuzimanja: 76

citiraj

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Sažetak

Ključne riječi

cardiac magnetic resonance; mitral annular disjunction; prolapse

Hrčak ID:

302571

URI

https://hrcak.srce.hr/302571

Datum izdavanja:

27.4.2023.

Posjeta: 195 *



Mitral annular disjunction (MAD) is the improper systolic acceptance of the posterior leaflet to the atrial wall (1). First line to the diagnosis is transthoracic echocardiography in the long axis view on the mitral valve using highest frame rate or sagittal view on cardiac magnetic resonance (CMR) (1). The distance between mitral-annulus and systolic bulge of ventricular myocardium range 5-10 mm is diagnostic and it is associated with morphological and functional remodeling of the left ventricular myocardium (1,2). Prevalence of MAD varies due to the different cut-offs, imaging modalities and ec, and in a general population, is 8.7% (3). In patients with mitral valve prolapse the prevalence of MAD is 20-58% (1). While MAD with prolapse is common and associated with ventricular arrhythmias, isolated MAD without prolapse, has been described on CMR (2,3). CMR can also identify prolapse using cine images, but the most important advantage of this technique is risk stratification of arrhythmias due to incremental prognostic value of late gadolinium enhancement over mitral valve prolapse severity (2). Several studies suggested association between late gadolinium enhancement (LGE) at the mid wall of papillary muscles and inferobasal region of left ventricle with complex arrhythmias (1-4). The origin of ventricular arrhythmia can be deduced according to the distribution of LGE on CMR (1,2). CMR should be done in all patients who survived sudden cardiac death or sustained ventricular arrhythmia before devices, to clarify the etiology and also in patients with unexplained syncope or nonsustained ventricular arrhythmia, to assessment of left ventricle size and function, severity of mitral regurgitation, leaflet thickness and also when is poor echocardiographic window (1). CMR imaging provides excellent morphological information and helps in the assessment of fibrosis (4). Myocardial fibrosis determined according to LGE at CMR was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction (2).

LITERATURE

1 

Sabbag A, Essayagh B, Barrera JDR, Basso C, Berni A, Cosyns B, et al. EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society. Europace. 2022 December 9;24(12):1981–2003. https://doi.org/10.1093/europace/euac125 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/35951656

2 

Figliozzi S, Georgiopoulos G, Lopes PM, Bauer KB, Moura-Ferreira S, Tondi L, et al. Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse. Radiology. 2023 January;306(1):112–21. https://doi.org/10.1148/radiol.220454 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/36098639

3 

Bennett S, Tafuro J, Duckett S, Appaji A, Khan JN, Heatlie G, et al. Definition, prevalence, and clinical significance of mitral annular disjunction in different patient cohorts: A systematic review. Echocardiography. 2022 March;39(3):514–23. https://doi.org/10.1111/echo.15299 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/35122307

4 

Kulkarni AA, Chudgar PD, Burkule NJ, Kamat NV. Mitral Annulus Disjunction and Arrhythmic Mitral Valve Prolapse: Emerging Role of Cardiac Magnetic Resonance Imaging in the Workup. Indian J Radiol Imaging. 2022 August 30;32(4):576–81. https://doi.org/10.1055/s-0042-1754357 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/36451946


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