MRI Snapshot of MAD

Mitral annular disjunction is a structural abnormality characterized by atrial displacement of the mitral valve annulus or leaflet hinge point away from the ventricular myocardium. This anomaly is frequently associated with mitral valve prolapse, leaflet degeneration, and fibrosis of the papillary muscles and myocardium, and is increasingly recognized as a substrate for malignant ventricular arrhythmias. Mitral annular disjunction contributes to paradoxical systolic annular expansion and has been linked to arrhythmogenic mitral valve prolapse, with a higher risk of ventricular arrhythmias and sudden cardiac death. A disjunction length of ≥5 mm is considered clinically significant for predicting arrhythmic risk. Cardiac magnetic resonance imaging plays a pivotal role in identifying and quantifying mitral annular disjunction, assessing coexistent mitral valve prolapse, and detecting myocardial and papillary muscle fibrosis. These insights are vital for risk stratification and guiding patient management, particularly regarding electrophysiological interventions and surgical repair.