Echocardiographic Assessment of Mitral Annular Disjunction With Cross-Correlation by Computed Tomography and Magnetic Resonance Imaging: A Case Series

Abstract

Mitral valve (MV) pathology, along with its associated peripheral anatomy, is one of the most common categories of heart disease. Two-dimensional (2D) transthoracic echocardiography (TTE) plays a prominent role in the detection and management of various types MV disease, specifically mitral annular disjunction (MAD). MAD is defined as a structural abnormality of the mitral annulus fibrosus, causing a noticeable gap between the atrial wall-mitral valve junction and the basilar portion of the left ventricular free wall (LV). The integral role that cardiac sonographers play in identifying MAD cannot be underscored, as well as the risk of easily overlooking this unique abnormality. Often associated with mitral valve prolapse (MVP), accurate documentation of MAD amid an echocardiographic study can have positive implications on patient prognosis. This case series highlights the echocardiographic characteristics of MAD, to raise awareness of this often forgotten feature of myxomatous mitral valves, which can indeed cause adverse patient outcomes. It is important to demonstrate correlational features with additional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT).