Mitral Annular Disruptions

Rachel L Goldberg; Eric Isselbacher; Sean P Murphy; Ignacio Inglessis-Azueja; Borek Foldyna; Nathaniel B Langer; Molly L Paras; Evin Yucel

doi:10.1016/j.jaccas.2025.104342

Mitral Annular Disruptions

JACC Case Rep. 2025 Jun 25;30(16):104342. doi: 10.1016/j.jaccas.2025.104342.

Authors

Rachel L Goldberg¹, Eric Isselbacher¹, Sean P Murphy², Ignacio Inglessis-Azueja¹, Borek Foldyna³, Nathaniel B Langer⁴, Molly L Paras⁵, Evin Yucel⁶

Affiliations

¹ Cardiovascular Disease Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Cardiovascular Disease Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
³ Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁴ Cardiac Surgery Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Cardiovascular Disease Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: eyucel@mgh.harvard.edu.

PMID: 40579097
DOI: 10.1016/j.jaccas.2025.104342

Abstract

Background: Mitral annular disruption is increasingly recognized in our clinical practice and is most commonly due to infective endocarditis or transcatheter or hybrid balloon-expandable mitral valve deployment in the setting of mitral annular calcification.

Case summary: A case series is presented of 4 patients with mitral annular disruption in 4 distinct clinical scenarios, each requiring multimodality imaging for diagnosis.

Discussion: These defects are often difficult to detect on transthoracic imaging and challenging to interpret on transesophageal echocardiography given the unique flow pattern and a general unfamiliarity among echocardiographers with such a defect.

Take-home messages: These 4 cases describe mitral annular disruption caused by infective endocarditis or mitral valve replacement in the setting of mitral annular calcification. These cases stress the importance of careful multimodality cardiac imaging and maintaining a high clinical suspicion for mitral annular disruption, as it is often challenging to diagnose.

Keywords: endocarditis; mitral valve replacement.

Publication types

Case Reports