Key result
MAD in myxomatous mitral valve disease is linked to ~22% larger end-systolic annular area.
Why the study?
In myxomatous mitral valve disease, mitral annular disjunction is associated with severe mitral regurgitation, yet functional analyses are lacking to fully understand the mechanisms leading to bileaflet prolapse. This study aimed to characterize left atrio-ventricular junction morphological alterations across the cardiac cycle using multiphase cardiac computed tomography imaging.
Does multiphase cardiac computed tomography imaging characterize left atrio-ventricular junction morphological alterations throughout the cardiac cycle in patients with myxomatous mitral valve disease and mitral annular disjunction compared to those without mitral annular disjunction and controls?
Observational (n=72)
Does multiphase cardiac computed tomography imaging characterize left atrio-ventricular junction morphological alterations throughout the cardiac cycle in patients with myxomatous mitral valve disease and mitral annular disjunction compared to those without mitral annular disjunction and controls?
Answers are grounded in this paper and cite their sources.
Multiphase cardiac CT reveals that in mitral annular disjunction, the mitral annulus becomes desynchronized from left ventricular function with exaggerated systolic expansion and papillary muscle shortening, which may promote bileaflet prolapse.
Objective Among myxomatous mitral valve disease (MMVD), mitral annular disjunction (MAD) is associated with severe mitral regurgitation (MR). However, functional analyses are lacking to fully understand the mechanisms leading to bileaflet prolapse in MAD. Using multiphase cardiac computed tomography imaging (4D-MCCTI), we aim to characterize left atrio-ventricular junction morphological alterations throughout the cardiac cycle in patients with MAD. Methods Imaging datasets were obtained via 4D-MCCTI for 2 groups of consecutive patients with severe MR due to MMVD: 22 with MAD (MMVD + MAD+) and 20 without (MMVD + MAD−). A control group of 30 patients (MMVD−) was also included. Semi-automated delineation of 18 points around the mitral annulus (MA) allowed 3D calculation of areas, perimeters, 360°-diameters, and planar/vertical deformation across time. Left ventricular (LV) and atrial (LA) inner contours were also delineated, and systolic shortening distances from the annulus to the anterior and posterior papillary muscles (MA-APM and MA-PPM) were estimated. Results Groups were comparable for age, pulmonary pressures, and LV ejection fraction. In MMVD + MAD+, MA expansion began earlier in systole, following LA expansion, and peaking at end-systole: 3D-area: 10.9±3.7cm 2 /m 2 , compared to 8.9±2.4 cm 2 /m 2 for MMVD + MAD− ( P < .001) and 6.1±1.3 cm 2 /m 2 for MMVD− ( P < .001). However, MA perimeter reduction remained unaltered in MMVD + MAD + patients (−14.7±5.2%). In systole, MA-APM and MA-PPM reduction were greater in MMVD + MAD+: −6.58±1.99 mm, −8.12±1.26 mm versus −2.53±2.01 mm, −3.25±2.31 mm in MMVD− and −2.18±1.79 mm, −3.86±2.77 mm in MMVD + MAD− ( P < .001). Conclusions In MAD, MA becomes desynchronized from LV function. The extent of systolic MA deformation and papillary muscle movement may promote bileaflet prolapse.
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Jouan et al. (2026) conducted an observational in Myxomatous mitral valve disease with mitral annular disjunction (n=72). Mitral annular disjunction in myxomatous mitral valve disease (MMVD + MAD+) vs. Myxomatous mitral valve disease without MAD (MMVD + MAD−) and controls without MMVD (MMVD−) was evaluated on End-systolic mitral annulus 3D-area (cm²/m²) (p=< .001). Mitral annular disjunction in MMVD exhibited greater end-systolic mitral annulus 3D-area than MMVD without MAD (10.9±3.7 vs 8.9±2.4 cm²/m²; P<.001) and controls (6.1±1.3 cm²/m²; P<.001).
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