195 A Case Of Mitral Annular Disjunction Presenting With Ventricular Arrhythmia

Abstract

Mitral annular disjunction (MAD) arrhythmic syndrome has been previously described but under-recognised in clinical practice.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We present a case of a 35-year-old female who was intubated and ventilated following out of hospital cardiac arrest requiring 6 minutes of cardiopulmonary resuscitation and 2 synchronized electrical cardioversion. Medical history is significant for known bileaflet mitral valve prolapse, mild mitral regurgitation with preserved systolic function. She has Hashimoto’s thyroiditis-on thyroxine and stable myasthenia gravis. Inpatient monitoring revealed frequent ventricular ectopy with multiple episodes of non-sustained ventricular tachycardia managed with amiodarone. Transthoracic Echocardiography (TTE) revealed mitral annular disjunction (MAD). Contrast Cardiac MRI (MRC) confirmed significant MAD measuring 10mm and significant lateral annular movement of approximately 2cm with typical curling movement of posterolateral wall. There was no focal early or late gadolinium enhancement. MRC findings of mildly dilated left ventricle with moderate LV systolic dysfunction and LVEF of 38% corresponds with TTE. Her CT coronary angiogram excluded coronary artery disease. She proceeded to insertion of an automated implantable cardioverter defibrillator and commencement of heart failure therapy with weaning of amiodarone. She has remained well since the index presentation with no device therapies. This case illustrates an example of MAD and associated risk of increased life-threatening arrhythmia. Management of this complex entity is uncertain and new research is needed to inform clinicians on how to best treat these patients.