Mitral Annular Disjunction: The Known Knowns and the Knowns Unknowns-Mitral Annular Disjunction: The Known Knowns and the Knowns Unknowns

Video Transcription

Video Summary

The discussion focuses on the complex field of risk stratification, management, and treatment for patients with mitral annular disjunction (MAD) and mitral valve prolapse (MVP). The panel of experts covered various aspects of the condition, from imaging techniques to identify MAD, to potential treatment avenues such as medication and surgery. Dr. Pavri and Dr. Chakrabarty discussed the importance of accurate diagnosis using imaging modalities like echocardiography and MRI, which help reveal morphology details and fibrosis levels associated with MAD and MVP. These factors are crucial for assessing the risk of ventricular arrhythmias, especially severe ones common in a tiny fraction of affected patients.<br /><br />Key risk factors include syncope, specific ECG changes, and certain anatomy observations such as bileaflet prolapse. While exercise ECG and MRI are often recommended for deeper evaluation, the European guidelines offer a stratified approach to risk. However, there is no single predictive marker. Decisions often depend on compounded risk factors. For management, strategies differ widely: beta-blockers are a common recommendation, while attempts at electrophysiological interventions like catheter ablation or mitral valve surgery might be considered based on individual patient characteristics and arrhythmia type.<br /><br />Debates on percutaneous interventions and their potential impact were also highlighted. Overall, the risk stratification and management of MAD are evolving and multifaceted, demanding an integrative approach balancing available evidence with individual patient nuances and continued monitoring for progressive arrhythmias even post-intervention.

Keywords

risk stratification

mitral annular disjunction

mitral valve prolapse

imaging techniques

ventricular arrhythmias

echocardiography

MRI

beta-blockers

catheter ablation

percutaneous interventions