Key result
Altered annular dynamics largely explain pseudo-MAD in MVP, with 78% exhibiting a systolic reverse-saddle shape.
Its licence doesn't allow us to show a copy here.
Why the study?
Systolic mitral annular disjunction in mitral valve prolapse may often be apparent rather than true anatomical disjunction, prompting analysis of annular shape and dynamics by 3D-TEE.
Does 3D-TEE analysis explain apparent systolic mitral annular disjunction (Pseudo-MAD) in patients with mitral valve prolapse?
Observational (n=225)
Does 3D-TEE analysis explain apparent systolic mitral annular disjunction (Pseudo-MAD) in patients with mitral valve prolapse?
Systolic mitral annular disjunction (Pseudo-MAD) in mitral valve prolapse is largely explained by altered annular dynamics, specifically a newly identified systolic reverse-saddle shape.
Altered annular shape may explain apparent MAD in MVP; hypothesis-generating for arrhythmic risk and management.
AIMS: Mitral annular disjunction (MAD) is considered an abnormal anatomical/functional feature in patients with mitral valve prolapse (MVP). Recent evidence suggests that in most cases, systolic disjunction is only apparent (Pseudo-MAD), because of altered annular dynamics, with the leaflet hinge point remaining anchored to the annulus. The aim of this study was to analyze mitral annular shape and dynamic function in patients with MVP by 3D transesophageal echocardiography (3D-TEE). METHODS AND RESULTS: Patients with MVP and ≥ grade 3 mitral regurgitation (MR) who underwent comprehensive 3D TEE evaluation were retrospectively included. Mitral annular shape and dynamic function were analyzed using 3D-TEE dataset and dedicated software. Two-hundred-twenty-five patients were included (77 with Pseudo-MAD, 14 with True-MAD). Among Pseudo-MAD, the majority (n=60, 78%), demonstrated an altered systolic annular conformation with a "reverse-saddle" shape. This reverse-saddle shape was less common in patients with No-MAD or with True-MAD (9% and 14%), who mostly exhibited a normal or flattened annular shape. Patients with Pseudo-MAD had greater degrees of valve degeneration, with longer mitral posterior leaflets (18 ± 3mm vs 15 ± 4 mm, p<0.01), larger annular diameters (systolic AP diameter 38 ± 4 mm vs 35 ± 6 mm, p<0.01; systolic and diastolic IC diameters 43 ± 5 mm vs 39 ± 6 mm and 44 ± 4 mm vs 40 ± 5 mm, respectively) and impaired sphincteric function. Pickelhaube sign and curling were common in both Pseudo-MAD and reverse-saddle shaped annulus. No differences in acute surgical outcomes were observed among groups. CONCLUSIONS: These findings provide a pathophysiological basis for the hypothesis that MAD, when evident only in systole (Pseudo-MAD), appears to be largely explained by altered annular dynamics and function, with a new identified systolic reverse-saddle shape.
No takes yet. Share an insight, caveat, or question.
Fiore et al. (2026) conducted an observational in Mitral valve prolapse (MVP) with ≥ grade 3 mitral regurgitation (n=225). Pseudo-MAD (apparent systolic mitral annular disjunction) vs. No-MAD or True-MAD was evaluated on Systolic reverse-saddle annular shape. Pseudo-MAD in mitral valve prolapse is largely explained by altered annular dynamics, with 78% of Pseudo-MAD patients exhibiting a systolic reverse-saddle shape vs 9% in No-MAD and 14% in True-MAD.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: