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“We are intrigued by the cases reported by Alfares et al and commend the authors for highlighting the association between mitral annular disjunction (MAD) and sudden cardiac arrest in pediatric patients. However, we would like to note that their measurement of MAD distance included both MAD and 'pseudo' MAD due to mitral valve prolapse (MVP), leading to an overestimation of MAD distance.”
Echocardiographic visibility of mitral annular disjunction and mitral valve prolapse can be masked by acute left ventricular dysfunction following cardiac arrest, necessitating repeat structural assessment after hemodynamic and systolic recovery before concluding a malignant ventricular arrhythmic event is idiopathic.
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Ahmad et al. (2026) conducted an editorial in Mitral annular disjunction (MAD) and malignant ventricular arrhythmia (n=4). Left ventricular systolic recovery after cardiac arrest vs. Early post-arrest moderate-to-severe left ventricular dysfunction was evaluated on Echocardiographic visibility of mitral annular disjunction (MAD).
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