PMC10400284_01
TTE and MRI, MAD noted with the red line.
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F1
TTE and TOE showed improved LV function (50% EF) and evidence of bileaflet MVP, severe mitral regurgitation, and MAD approximately 16 mm, not clearly visualized on initial imaging (Figure 1). The CMR showed significant annulus disjunction of the posterior leaflet of MV (Figure 1), measuring up to 16 mm, severe bileaflet MVP, and severe MR with posteriorly directed eccentric jet (Supplementary Video S1).
PMC10400284_02
Transthoracic and MRI long-axis views. The red line and red arrow indicate the MAD area.
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F2
A complete TTE and TEE study that followed revealed a mildly dilated LV with borderline normal LVEF and MAD (Figures 2,3, Supplementary Videos S2, S3). The cardiac magnetic resonance report an unveiled annular disjunction of the posterior LV wall, measuring a longitudinal MAD distance of 8 mm (Figure 2), with late gadolinium enhancement due to fibrosis in the anterolateral papillary muscle and basal posterolateral left ventricle.
Transesophageal view of MAD (red line and red arrow).
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F3
A complete TTE and TEE study that followed revealed a mildly dilated LV with borderline normal LVEF and MAD (Figures 2,3, Supplementary Videos S2, S3).