Furukawa Koji, Iwasaki Ayaka, Ishii Hirohito, Shuhei Sakaguchi, Mori Kousuke, Hiromatsu Shohei
Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki City, Miyazaki, 889-1692, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Mar 4;4(1):11. doi: 10.1186/s44215-025-00196-4.
Mitral annular disjunction (MAD) is characterized by the detachment of the mitral valve-left atrial junction from the left ventricular myocardium. The association of MAD with Barlow's disease and its relevance to treatment are increasingly recognized.
A 75-year-old male with a history of mitral regurgitation (MR) and ablation for paroxysmal atrial fibrillation was diagnosed with severe MR due to Barlow's disease, as confirmed by echocardiography. Imaging revealed disjunction at the mitral valve's posterior annulus. During surgery, the posterior leaflet was resected along the annulus with precise height adjustments. A 6-mm separation between the mitral valve-left atrial junction and the left ventricular myocardium was sutured using a four-stitch mattress technique. The procedure included leaflet repair, insertion of artificial chordae, and mitral annuloplasty. Postoperatively, the MAD was corrected successfully, eliminating the severe MR.
Confirming the presence of MAD before surgery is essential for patients with MR. Surgical correction of MAD is imperative when present to address the disjunction effectively.
二尖瓣环分离（MAD）的特征是二尖瓣-左心房连接处与左心室心肌分离。MAD与巴洛病的关联及其与治疗的相关性越来越受到认可。
一名75岁男性，有二尖瓣反流（MR）病史且因阵发性心房颤动接受过消融治疗，经超声心动图证实因巴洛病诊断为严重MR。影像学检查显示二尖瓣后瓣环分离。手术中，沿着瓣环切除后叶并精确调整高度。采用四针褥式缝合技术缝合二尖瓣-左心房连接处与左心室心肌之间6毫米的间隙。手术包括瓣叶修复、人工腱索植入和二尖瓣环成形术。术后，MAD得到成功纠正，消除了严重MR。
对于MR患者，术前确认MAD的存在至关重要。当存在MAD时，手术矫正对于有效解决分离问题势在必行。
