Introduction
Mitral annular disjunction (MAD) is a structural abnormality of the
mitral valve apparatus that is characterized by a separation between the
atrial wall of the mitral annulus and the ventricular myocardium (1).
This relatively new entity has been increasingly recognized in cardiac
imaging studies in recent years and it is shown to be associated with
mitral valve prolapse, mitral regurgitation, arrhythmic events, and
sudden cardiac death. Its prevalence is found to be over 8% in general
population and this number reaches up to four fold in patients with
mitral valve prolapse (2).
Abnormal atrial attachment of the posterior leaflet and related systolic
curling is observed in MAD which accompanies mechanical annular
dysfunction (3). MAD may contribute to mitral valve dysfunction by
altering the geometry of the mitral valve annulus or by disrupting the
continuity of the subvalvular apparatus (4). Moreover, it has been
suggested that MAD may be associated with myocardial dysfunction that
can be detected by abnormal myocardial strain. Separation between the
atrial wall of the mitral annulus and the ventricular myocardium may
disrupt myocardial mechanics, leading to decreased strain (5).
Additionally, there may be a direct effect of MAD on the mitral valve,
leading to mitral regurgitation and increased afterload on the left
ventricle, which may also contribute to myocardial dysfunction (2,5).
There are limited number of studies in the literature that examined the
strain parameters in MAD and the information about this subject is not
enough to define a particular pattern. In the present study, our aim was
to investigate the impact of mitral valve prolapse (MVP) on myocardial
strain parameters.