Advanced Imaging of Mitral Annular Disjunction: Where Are We?

Mitral annular disjunction (MAD) is a structural abnormality characterized by the separation of the mitral valve annulus from the left ventricular myocardium, often in association with mitral valve prolapse (MVP). Initially identified in the 1980s, MAD was not considered clinically significant at the time. However, recent advancements in imaging techniques have renewed interest in its potential role in mitral valve dysfunction and arrhythmias. Several studies have suggested a possible association with arrhythmogenic events, including non-sustained ventricular tachycardia. Nonetheless, its independent role in arrhythmogenesis remains a subject of debate. Advanced imaging techniques, particularly cardiac magnetic resonance (CMR), have proven valuable for diagnosing MAD and evaluating its implications, especially by detecting myocardial fibrosis. This review aims to provide a comprehensive overview of the current literature on MAD, with a focus on its diagnosis, clinical significance, and the application of advanced imaging modalities such as cardiac computed tomography (CCT) and CMR.