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The role of mitral annular disjunction and mitral valve prolapse in the arytmogenesis of ventricular arrhythmias

Authors: Ryzhova T.S., Khotsanyan C.V., Bulaeva N.I.

Company: Bakоulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2024-18S-S34-S42

For citation: Ryzhova T.S., Khotsanyan C.V., Bulaeva N.I. The role of mitral annular disjunction and mitral valve prolapse |in the arytmogenesis of ventricular arrhythmias. Creative Cardiology. 2024; 18 (Special Issue): S34–S42 (in Russ.). DOI: 10.24022/1997-3187-2024-18S-S34-S42

Received / Accepted:  02.10.2024 / 23.10.2024

Keywords: mitral annular disjunction arrhythmic mitral valve prolapse arrhythmic risk sudden cardiac death

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Abstract

Mitral annular disjunction (MAD) is a systolic atrial displacement of the hinge point of the posterior mitral valve, characterized by a distinct separation of the mitral valve ring, the wall of the left atrium and the basal part of the left ventricular myocardium. This anomaly has a complex heterogeneous structure with significant individual variations and is characterized by paradoxical dynamics of the fibrous ring during the cardiac cycle, which leads to abnormal mechanical stress on valvular and subvalvular structures and creates prerequisites for the formation of myocardial fibrosis, acting as an arrhythmogenic substrate. Increased interest in disjunction is associated with confirmation of the association of MAD with ventricular arrhythmias, sudden cardiovascular death and arrhythmogenic mitral valve prolapse (MVP).

This review covers the main aspects related to MAD, concerning the peculiarities of its distribution in the population, structure and dynamics during the cardiac cycle, as well as the relationship with PMK and the role in the arimogenesis of ventricular arrhythmias.

References

  1. Sabbag А., Essayagh B., Barrera J., Basso C., Berni A., Cosyns B. et al. EHRA expert consensus statement on arrhythmic mitral valve prolapse and mitral annular disjunction complex in collaboration with the ESC Council on valvular heart disease and the European Association of Cardiovascular Imaging endorsed cby the Heart Rhythm Society, by the Asia Pacific Heart Rhythm Society, and by the Latin American Heart Rhythm Society. Europace. 2022; 24 (12): 1981–2003. DOI: 10.1093/europace/euac125
  2. Dejgaard L.A., Stokke M.K., Hegbom F., Scheirlynck E.S., Gjertsen E., Andresen K. et al. The mitral annulus disjunction arrhythmic syndrome. J. Am. Coll. Cardiol. 2018; 72 (14): 1600–1609. DOI: 10.1016/j.jacc.2018.07.070
  3. Gilbert B.W., Schatz R.A., VonRamm O.T., Behar V.S., Kisslo J.A. Mitral valve prolapse. Two-dimensional echocardiographic and angiographic correlation. Circulation. 1976; 4 (5): 716–723. DOI: 10.1161/01.cir.54.5.716
  4. Bharati S., Granston A.S., Liebson P.R., Loeb H.S., Rosen K.M., Lev M. The conduction system in mitral valve prolapse syndrome with sudden death. Am. Heart J. 1981; 101 (5): 667–670. DOI: 10.1016/0002-8703(81)90235-0
  5. Hutchins G.M., Moore G.W., Skoog D.K. The association of floppy mitral valve with disjunction of the mitral annulus fibrosus. N. Engl. J. Med. 1986; 314: 535–540. DOI: 10.1056/NEJM198602273140902
  6. Wunderlich N.C., Ho S.Y., Flint N., Siegel R.J. Myxomatous mitral valve disease with mitral valve prolapse and mitral annular disjunction: clinical and functional significance of the coincidence. J. Cardiovasc. Dev. Dis. 2021; 8 (2): 9. DOI: 10.3390/jcdd8020009
  7. Basso C., Perazzolo Marra M. Mitral annulus disjunction: emerging role of myocardial mechanical stretch in arrhythmogenesis. J. Am. Coll. Cardiol. 2018; 72 (14); 1610–1612. DOI: 10.1016/j.jacc.2018.07.069
  8. Gulati A., Gulati V., Hu R., Rajiah P.S., Stojanovska J., Febbo J. et al. Mitral annular disjunction: review of an increasingly recognized mitral valve entity. Radiology. Cardiothorac. Imag. 2023; 5 (6): e230131. DOI: 10.1148/ryct.230131
  9. Groeneveld S.A., Kirkels F.P., Cramer M.J., Evertz R., Haugaa K.H., Postema P.G. et al. Prevalence of mitral annulus disjunction and mitral valve prolapse in patients with idiopathic ventricular fibrillation. J. Am. Heart Assoc. 2022; 11 (16): e025364. DOI: 10.1161/JAHA.121.025364
  10. Zhu L., Chua Y.L. Mitral annular disjunction: clinical implications and surgical considerations. Cardiol. Research. 2023; 14 (6): 421–428. DOI: 10.14740/cr1584
  11. Nagata Y., Bertrand P.B., Levine R.A. Malignant mitral valve prolapse: risk and prevention of sudden cardiac death. Curr. Treat. Options Cardiovasc. Med. 2022; 24 (5): 61–86. DOI: 10.1007/s11936-022-00956-3
  12. Putnam A.J., Kebed K., Mor-Avi V., Rashedi N., Sun D., Patel B. et al. Prevalence of mitral annular disjunction in patients with mitral valve prolapse and severe regurgitation. Int. J. Cardiovasc. Imaging. 2020; 36 (7): 1363–1370. DOI: 10.1007/s10554-020-01818-4
  13. Essayagh B., Sabbag A., Antoine C., Benfari G., Yang L.T., Maalouf J. et al. Presentation and outcome of arrhythmic mitral valve prolapse. J. Am. Coll. Cardiol. 2020; 76: 637–649. DOI: 10.1016/j.jacc.2020.06.029
  14. Bennett S., Thamman R., Griffiths T., Oxley C., Khan J.N., Phan T. et al. Mitral annular disjunction: a systematic review of the literature. Echocardiography (Mount Kisco, N.Y.). 2019; 36 (8): 1549–1558. DOI: 10.1111/echo.14437
  15. Konda T., Tani T., Suganuma N. Mitral annular disjunction in patients with primary severe mitral regurgitation and mitral valve prolapse. Echocardiography. 2020; 37: 1716–1722. DOI: 10.1111/echo.14896
  16. Essayagh B., Sabbag A., Antoine C., Benfari G., Batista R., Yang L.T. et al. The mitral annular disjunction of mitral valve prolapse: presentation and outcome. JACC Cardiovasc. Imaging. 2021; 14: 2073–2087. DOI: 10.1016/j.jcmg.2021.04.029
  17. Chivulescu M., Krohg-Sorensen K., Scheirlynck E., Lindberg B.R., Dejgaard L.A., Lie O.H. et al. Mitral annulus disjunction is associated with adverse outcome in Marfan and Loeys–Dietz syndromes. Eur. Heart J. Cardiovasc. Imaging. 2021; 22 (9): 1035–1044. DOI:
  18. Zugwitz D., Fung K., Aung N., Rauseo E., McCracken C., Cooper J. et al. Mitral annular disjunction assessed using CMR imaging: insights from the UK biobank population study. JACC Cardiovasc. Imaging. 2022; 15 (11): 1856–1866. DOI: 10.1016/j.jcmg.2022.07.015
  19. Wu S., Siegel R.J. Mitral annular disjunction: a case series and review of the literature. Front. Cardiovasc. Med. 2022; 9: 976066. DOI: 10.3389/fcvm.2022.976066
  20. Apostolou F., Ioannides M., Mitsis A., Koutsofti C., Deltas C., Avraamides P. Case report: Aborted sudden cardiac death as a first presentation of severe mitral annulus disjunction – a case series and review of the literature. Front. Cardiovasc. Med. 2023; 10: 1171226. DOI:
  21. Faletra F., Leo L., Paiocchi V., Schlossbauer S., Pavon A., Ho S., Maisano F. Morphology of mitral annular disjunction in mitral valve prolapse. J. Am. Soc. Echocardiogr. 2022; 35 (2): 176–186. DOI: 10.1016/j.echo.2021.09.002
  22. Robinson S., Ring L., Augustine D.X., Rekhraj S., Oxborough D., Harkness A. et al. The assessment of mitral valve disease: a guideline from the British Society of Echocardiography. Echo Res. Pract. 2021; 8 (1): G87–136. DOI: 10.1530/ERP-20-0034
  23. Lee A.P., Jin C.N., Fan Y., Wong R.H.L., Underwood M.J., Wan S. Functional implication of mitral annular disjunction in mitral valve prolapse: a quantitative dynamic 3d echocar

About Authors

  • Taisia S. Ryzhova, resident; ORCID
  • Chinara V. Khotsanyan, Cand. Med. Sci., Cardiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Associate Professor, Head of the Department, Cardiologist; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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