Mitral Annulus Disjunction - An Underdiagnosed Anatomic Morphology: Review of Literature

Mitral annular disjunction (MAD) is an easily identifiable entity on transthoracic echocardiography, but is still poorly recognized or ignored. It is often associated with mitral valve prolapse and is itself a risk marker for ventricular arrhythmias and sudden cardiac death. We present here a case of 54 year Indian male presenting with MVP accompanied by significant mitral annulus disjunction (MAD) in whom a comprehensive transthoracic echocardiography (TTE) and 4Dimensional X Strain speckle tracking imaging was conducted to estimate the MAD distance and importantly, various LV strain parameters were evaluated to discover any early markers of LV aberration by LV strain imaging by 4Dimensional X Strain speckle tracking echocardiography (4DXStrain STE). Keywords: Mitral annulus disjunction, MAD, Mitral annulus prolapse, Ventricular arrhythmias in MAD, SCD in MAD, LV strain imaging in MAD.