IMR Press / RCM / Volume 23 / Issue 4 / DOI: 10.31083/j.rcm2304117
Open Access Review
Mitral Annular Disjunction: Pathophysiology, Pro-Arrhythmic Profile and Repair Pearls
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1 Department of Cardiac Surgery, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece
2 Third Department of Cardiac Surgery, Onassis Cardiac Surgery Center, 10671 Athens, Greece
3 Department of Echocardiography, Mitera Hospital, 15123 Athens, Greece
4 Department of Cardiac Surgery, Mitera Hospital, 15123 Marousi, Athens, Greece
5 Cardiology Department, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
6 Department of Congenital Cardiology, Mitera Hospital, 15123 Marousi, Athens, Greece
7 School of Biomedical Engineering & Imaging Sciences, King’s College London, NW3 3 London, UK
*Correspondence:; (Dimos Karangelis)
These authors contributed equally.
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2022, 23(4), 117;
Submitted: 20 December 2021 | Revised: 14 February 2022 | Accepted: 25 February 2022 | Published: 30 March 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Mitral annular disjunction (MAD) is a structural abnormality defined by a distinct separation of the mitral valve annulus—left atrial wall continuum and the basal aspect of the posterolateral left ventricle. This anomaly is often observed in patients with myxomatous mitral valve prolapse. Importantly, MAD has been strongly associated with serious ventricular arrhythmias and predisposes to sudden cardiac death. Therefore, we have to emphasize the need to diagnose this morphologic and functional abnormality in routine practice in order to facilitate optimal mitral valve repair and minimize patient risks. Nevertheless, clinical knowledge regarding MAD still remains limited. In the present review, we aim to shed light on several aspects of MAD, including distinct anatomical and pathophysiological characteristics, imaging modalities, association with ventricular arrhythmias, and current methods of treatment.

mitral disjunction
mitral valve prolapse
mitral regurgitation
lethal arrhythmias
ventricular arrhythmias
mitral valve repair
mitral surgery
Fig. 1.
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