Author + information
- Francesca Mantovani,
- Giovanni Benfari,
- Marie-Annick Clavel,
- Joseph F. Maalouf,
- Sunil Mankad,
- Hector Michelena,
- Rakesh Suri,
- Simon Maltais and
- Maurice Sarano
Background: Mitral annular disjunction (MAD) is a localized detachment of annulus supporting the posterior leaflet from ventricular wall, described in myxomatous valve disease (MMVD). Whether this localized detachment causes physiologic consequences for annular and valvular dynamics is unknown.
Methods: In 61 patients with MMVD and severe regurgitation 3D-transesophageal echo quantified dynamic mitral annular and leaflets’ dimensions throughout the cardiac cycle. MAD was diagnosed by 2D echo from long axis views in systole.
Results: MAD was detected in 27 (44%) patients. Annular measurements in diastole showed in MAD larger annular area (1557±58 vs. 1402±52 mm2, p=0.04) and intercommissural diameter (47.0±4.9 vs. 44.0±5.6mm, p=0.03) than without MAD. Annular dynamic analysis (fig) showed early-systolic contraction and saddle shape accentuation similar with and without MAD. However, in MAD mid- and late-systolic inter-commissural diameter increased leading to excess (vs. non-MAD) late-systolic annular area and circumference enlargement (all p<0.0001). Despite posterior annular displacement, in systole mitral prolapse volume (4.3±4.2 vs. 1.8±1.9 ml, p=0.002) was larger with vs. without MAD related to larger leaflet area (2053±629 vs. 1692±488 mm, p=0.01).
Conclusions: MAD is frequent in MMVD. MAD does not affect early systolic annular function but is associated with late-systolic inter-commissural annular enlargement, which despite larger leaflets contributes mal-coaptation.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: New Technologies in Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1245-207
- 2017 American College of Cardiology Foundation