Radiology Cardiothoracic Imaging Podcast | RSNA Episode 23: Mitral Annular Disjunction
Feb 22, 2024
Behzad Pavri, an electrophysiologist and professor, offers clinical arrhythmia perspective. Bhaskaran Sundaram, a cardiothoracic radiologist, shares imaging and outcome expertise. Aishwarya Gulati, a radiologist-researcher, explains measurement and pitfalls. They discuss what mitral annular disjunction is, its ties to mitral prolapse and arrhythmia, imaging techniques, and the need for consensus and research.
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MAD Is Defined By Displacement But Lacks Consensus
- Mitral annular disjunction (MAD) is atrial displacement of the mitral annulus but lacks a single consensus definition.
- Up to ~5 mm displacement may be common and not necessarily pathologic, so context matters for clinical relevance.
Pathology Cases Sparked Early Recognition Of MAD
- Historical pathology and echocardiography reports from the 1970s–1980s first described atrioannular decoupling leading to the term mitral annular disjunction.
- Dr. Bharati's autopsy case and a 900-autopsy series helped cement MAD as a recognized pathologic entity.
Risk Is Greatest When MAD And Prolapse Coexist
- MAD often coexists with mitral valve prolapse but the combinations vary: disjunction without prolapse, prolapse without disjunction, and both together.
- The highest arrhythmic risk appears in the subgroup with bileaflet prolapse, myxomatous changes, elongated subvalvular apparatus, and disjunction.