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Journal of Echocardiography

, Volume 15, Issue 4, pp 176–185 | Cite as

The analysis of mitral annular disjunction detected by echocardiography and comparison with previously reported pathological data

  • Toshiko Konda
  • Tomoko Tani
  • Naoko Suganuma
  • Hitomi Nakamura
  • Toshiaki Sumida
  • Yoko Fujii
  • Junichi Kawai
  • Takeshi Kitai
  • Kitae Kim
  • Shuichiro Kaji
  • Yutaka Furukawa
Original Investigation
  • 195 Downloads

Abstract

Background

Mitral annular disjunction is a structural abnormality of the mitral annulus fibrosus and is pathologically defined by a separation between the atrial wall–mitral valve junction and the left ventricular attachment. Mitral annular disjunction can cause hypermobility of the mitral valve apparatus and is often associated with mitral valve prolapse (MVP). The aim of this study was to investigate the frequency and characteristics of mitral annular disjunction in the patients referred to an echocardiography laboratory and to compare these with previously reported pathological data.

Methods and results

We retrospectively studied 1439 patients (mean age 65 ± 17 years, 58% male) referred to our echocardiography laboratory from 6 January 2014 to 31 March 2014. The echocardiographic parameters were compared between the patients with and without mitral annular disjunction. There were 125 cases (8.7%) with mitral annular disjunction, of which 15 (12%) also had MVP. The number of MVP patients in the group with mitral annular disjunction was significantly larger than in the group without mitral annular disjunction (p < 0.0001). The grade of mitral regurgitation was not significantly different between the two groups.

Conclusions

Mitral annular disjunction was detected not only in patients with a myxomatous mitral valve but also in normal cases. The number of MVPs was significantly larger in patients with mitral annular disjunction than patients without mitral annular disjunction. Further investigation is needed to clarify the clinical significance of the mitral annular disjunction detected by routine echocardiography.

Keywords

Mitral annular disjunction Mitral regurgitation Mitral valve prolapse Transthoracic echocardiography Pathology 

Notes

Author contributions

TK and TT were responsible for study design, analysis and interpretation of data, and manuscript drafting. NS, HN, TS, YF, JK, KK, TK, and SK were responsible for study design and interpretation of data. YF supervised and commented on the manuscript.

Compliance with ethical standard

Conflict of interest

Toshiko Konda, Tomoko Tani, Naoko Suganuma, Hitomi Nakamura, Toshiaki Sumida, Yoko Fujii, Junichi Kawai, Takeshi Kitai, Kitae Kim, Shuichiro Kaji, and Yutaka Furukawa declare that they have no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Hutchins GM, Moore GW, Skoog DK. The association of floppy mitral valve with disjunction of the mitral annulus fibrosus. N Engl J Med. 1986;314:535–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Angelini A, Ho SY, Anderson RH, et al. A histological study of the atrioventricular junction in hearts with normal and prolapsed leaflets of the mitral valve. Br Heart J. 1988;59:712–6.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Enriquez-Sarano M, Bailey KR, Seward JB, et al. Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993;87:841–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003;16:777–802.CrossRefPubMedGoogle Scholar
  5. 5.
    Otto CM, Bonow RO. Valvular heart disease. A companion to Braunwald’s heart disease. 4th ed. Philadelphia: Elsevier; 2013. p. 363–4.Google Scholar
  6. 6.
    Carmo P, Andrade MJ, Aguiar C, et al. Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography. Cardiovasc Ultrasound. 2010;8:53.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Nistri S, Galderisi M, Ballo P, et al. Determinants of echocardiographic left atrial volume: implications for normalcy. Eur J Echocardiogr. 2011;12(11):826–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Shin SY, Lim HE, Choi UJ, et al. Impaired transport function of the left atrium in patients with lone paroxysmal atrial fibrillation. Echocardiography. 2011;28(1):44–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Eriksson MJ, Bitkover CY, Omran AS, et al. Mitral annular disjunction in advanced myxomatous mitral valve disease: echocardiographic detection and surgical correction. J Am Soc Echocardiogr. 2005;18:1014–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Hsiao SH, Lin KL, Chiou KR. Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol. 2012;109(5):748–55.CrossRefPubMedGoogle Scholar
  11. 11.
    de Becker AE. Wit APM. Mitral valve apparatus. A spectrum of normality relevant to mitral valve prolapse. Br Heart J. 1979;42:680–9.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Pini R, Greppi B, Kramer-Fox R, et al. Mitral valve dimensions and motion and familial transmission of mitral valve prolapse with and without mitral leaflet billowing. J Am Coll Cardiol. 1988;12:1423–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Ormiston JA, Shah PM, Tei C, et al. Size and motion of the mitral valve annulus in man. II. Abnormalities in mitral valve prolapse. Circulation. 1982;65(4):713–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Clavel MA, Mantovani F, Malouf J, et al. Dynamic phenotypes of degenerative myxomatous mitral valve disease. Quantitative 3-dimensional echocardiographic study. Circ Cardiovasc Imaging. 2015;8:e002989.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2017

Authors and Affiliations

  • Toshiko Konda
    • 1
  • Tomoko Tani
    • 2
  • Naoko Suganuma
    • 1
  • Hitomi Nakamura
    • 1
  • Toshiaki Sumida
    • 1
  • Yoko Fujii
    • 1
  • Junichi Kawai
    • 1
  • Takeshi Kitai
    • 3
  • Kitae Kim
    • 3
  • Shuichiro Kaji
    • 3
  • Yutaka Furukawa
    • 3
  1. 1.Department of Clinical TechnologyKobe City Medical Center General HospitalKobeJapan
  2. 2.Basic Medical ScienceKobe City College of NursingKobeJapan
  3. 3.Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan

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