Mitral Annular Disjunction: Pathophysiology, Pro-Arrhythmic Profile and Repair Pearls.

Mitral annular disjunction (MAD) is a structural abnormality defined by a distinct separation of the mitral valve annulus-left atrial wall continuum and the basal aspect of the posterolateral left ventricle. This anomaly is often observed in patients with myxomatous mitral valve prolapse. Importantly, MAD has been strongly associated with serious ventricular arrhythmias and predisposes to sudden cardiac death.

The prognostic value of exercise-induced pulmonary hypertension in asymptomatic patients with primary mitral regurgitation.

Background: We examined whether the early development of exercise-induced pulmonary hypertension (EIPH) and right ventricular dysfunction during exercise stress echocardiography (ESE) may predict clinical deterioration in so-called "asymptomatic" patients with primary, at least moderate mitral regurgitation (MR).

Methods: 79 consecutive patients underwent a symptom-limited, graded ESE protocol on semi-supine bicycle at the beginning of the study. During the test, we assessed symptom development, test duration, and the following echocardiographic parameters: MR severity, maximum velocity of the tricuspid regurgitation jet (TR Vmax), pulmonary artery systolic pressure (PASP), and tricuspid annulus systolic excursion (TAPSE).

An alternative approach for complicated prosthetic aortic valve endocarditis.

Background: Surgical treatment of prosthetic valve endocarditis (PVE) with destruction of the aortic root and aortomitral continuity is demanding even in experienced hands.

Case Presentation: Herein, we describe a case of a 71-year-old female patient who presented with PVE that was further complicated by a fistulous abscess cavity. The patient underwent removal of the dehisced prosthetic valve, radical annular debridement, reconstruction of the aortomitral curtain with a pericardial patch as a patch exclusion technique and implantation of a sutureless valve.