MITRAL ANNULAR DISJUNCTION PREVALENCE AND PHYSIOLOGIC CONSEQUENCES IN DEGENERATIVE MITRAL REGURGITATION: A DYNAMIC 3-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY

MITRAL ANNULAR DISJUNCTION PREVALENCE AND PHYSIOLOGIC CONSEQUENCES IN DEGENERATIVE MITRAL REGURGITATION: A DYNAMIC 3-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY

1572 JACC March 21, 2017 Volume 69, Issue 11 Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) MITRAL ANNULAR DISJUNCTION PREVALENCE A...

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1572 JACC March 21, 2017 Volume 69, Issue 11

Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) MITRAL ANNULAR DISJUNCTION PREVALENCE AND PHYSIOLOGIC CONSEQUENCES IN DEGENERATIVE MITRAL REGURGITATION: A DYNAMIC 3-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: New Technologies in Echocardiography Abstract Category: 28. Non Invasive Imaging: Echo Presentation Number: 1245-207 Authors: Francesca Mantovani, Giovanni Benfari, Marie-Annick Clavel, Joseph F. Maalouf, Sunil Mankad, Hector Michelena, Rakesh Suri, Simon Maltais, Maurice Sarano, Mayo Clinic, Rocheter, MN, USA Background: Mitral annular disjunction (MAD) is a localized detachment of annulus supporting the posterior leaflet from ventricular wall, described in myxomatous valve disease (MMVD). Whether this localized detachment causes physiologic consequences for annular and valvular dynamics is unknown. Methods: In 61 patients with MMVD and severe regurgitation 3D-transesophageal echo quantified dynamic mitral annular and leaflets’ dimensions throughout the cardiac cycle. MAD was diagnosed by 2D echo from long axis views in systole.

Results: MAD was detected in 27 (44%) patients. Annular measurements in diastole showed in MAD larger annular area (1557±58 vs. 1402±52 mm2, p=0.04) and intercommissural diameter (47.0±4.9 vs. 44.0±5.6mm, p=0.03) than without MAD. Annular dynamic analysis (fig) showed early-systolic contraction and saddle shape accentuation similar with and without MAD. However, in MAD mid- and latesystolic inter-commissural diameter increased leading to excess (vs. non-MAD) late-systolic annular area and circumference enlargement (all p<0.0001). Despite posterior annular displacement, in systole mitral prolapse volume (4.3±4.2 vs. 1.8±1.9 ml, p=0.002) was larger with vs. without MAD related to larger leaflet area (2053±629 vs. 1692±488 mm, p=0.01). Conclusions: MAD is frequent in MMVD. MAD does not affect early systolic annular function but is associated with late-systolic intercommissural annular enlargement, which despite larger leaflets contributes mal-coaptation.