Abstract
A 50 years old male patient previously treated for pulmonary Kochs presented with shortness of breath (functional class II). A non-ejection click and pan-systolic murmur radiating to axilla was heard at apex. Transthoracic echocardiography revealed thickened and markedly prolapsing both leaflets of mitral valve with mild to moderate regurgitation. A clear space was noted between the termination of LV myocardium and atrio-mitral junction (7.7mm) indicating Mitro-annular disjunction (MAD). 24 hours Holter monitoring showed 160 isolated premature ventricular contractions, maximum 20 in one hour. No other arrhythmia was recorded. Beta blocker and an ACE inhibitor were initiated with advice for follow-up as presently no intervention was needed.
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