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Mitral annular disjunction (MAD) is pathologically defined by a separation between atrial wall-mitral valve (MV) junction and the left ventricular attachment.
We studied 718 consecutive patients (65±21years) referred to our echocardiography laboratory from June to July in 2010. The upper limit of the disjunction was defined at the level of posterior scallop insertion into the left atrial (LA) wall, whereas the lower limit of the disjunction was defined at the level of LA connection with ventricular myocardium. The distance between two levels was measured as MAD. LA diameter and tissue Doppler imaging (TDI) were compared between 45 patients with MAD and 673 patients without MAD. The severity of mitral regurgitation (MR) was semiquantitatively evaluated. We divided the patients with MAD. Type Iwas defined as no distance of MV junction, but the hypermobility of the mitral annulus. Type II was defined as <5 mm of the diameter of MAD and Type IIIwas as ⊠ 5 mm.
LA diameter was significantly smaller in cases with MAD than those without MAD (3.07±0.38 vs. 3.66±0.53, P<0.0001). The results of 77 patients with MR were shown. Septal, lateral and posterior TDI were significantly greater in patients with MAD than those without MAD (septal: 12.0±3.0 vs. 7.3±2.9, p<0.0001; lateral: 13.0±3.4 vs. 9.2±3.3, p<0.0001; posterior: 14.3±3.2 vs. 9.5±3.4, p<0.0001).
MAD was detected not only in patients with severe MR, but also in patients with almost normal MV. We found the some variation of MAD.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Multimodality Imaging in Valvular Heart Disease
Abstract Category: 18. Imaging: Echo
Presentation Number: 1270-352
- 2013 American College of Cardiology Foundation