{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:48:08Z","timestamp":1785815288226,"version":"3.56.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Ultrasound"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Mitral annular disjunction (MAD), a structural abnormality associated with mitral valve prolapse (MVP), is understudied in pediatric populations. This study aims to evaluate the clinical and laboratory characteristics of pediatric patients with MAD detected by transthoracic echocardiography (TTE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 27 patients (aged 5\u201317\u2009years, median 13, 81% female) diagnosed with MAD via TTE between 2019 and 2024 at a pediatric cardiology clinic. In addition to the traditional parameters with TTE, the Pickelhaube sign was investigated with tissue Doppler imaging. Cardiac magnetic resonance imaging (CMR) and 24\u2010h Holter electrocardiogram (ECG) monitoring were performed as further examinations. Data were reported as medians (range), means\u2009\u00b1\u2009standard deviations and percentages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All MAD patients included in the study had MVP and 74% had bi\u2010leaflet disease. The median MAD distance measured by TTE was 6.8\u2009mm (ranged 3.7\u201312.3\u2009mm). The Pickelhaube sign was present in 48.1%. Posterobasal global longitudinal strain (GLS) was reduced (median \u221215%, range \u22125% to \u221225%). T wave inversion (defined as negative T\u2010wave of \u2265\u20091\u2009mm in depth in two or more contiguous leads) in the inferior leads (II, III and AVF) was observed at 14 patients (51.8%). Supraventricular tachycardia (SVT) was detected in four of 21 patients who underwent 24\u2010h rhythm Holter monitoring. Late gadolinium enhancement consistent with focal fibrosis was present in 3 of 13 patients who underwent CMR (23%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>T wave inversion, SVT, fibrosis, and low GLS in pediatric MAD patients may represent prognostic indicators. Long\u2010term follow\u2010up is needed to clarify cardiac event risks. Early detection of congenital MAD remains important for longitudinal monitoring and pediatric arrhythmia management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcu.70366","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:41:32Z","timestamp":1785814892000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characteristics and Clinical Features of Mitral Annular Disjunction in the Pediatric Population"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4080-3919","authenticated-orcid":false,"given":"\u015e\u00fckr\u00fc Taylan","family":"\u015eahin","sequence":"first","affiliation":[{"name":"Department of Cardiology Amerikan Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9310-3767","authenticated-orcid":false,"given":"Bet\u00fcl Cengiz","family":"El\u00e7io\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amerikan Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5882-3083","authenticated-orcid":false,"given":"Terman","family":"G\u00fcm\u00fc\u015f","sequence":"additional","affiliation":[{"name":"Department of Radiology Amerikan Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7887-1963","authenticated-orcid":false,"given":"Alpay","family":"\u00c7eliker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology Amerikan Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","DOI":"10.4081\/cp.2017.946","article-title":"Disappearance of Electrocardiographic Abnormalities Associated With the Arrhythmic Pattern of a Barlow Disease After Surgical Mitral Valve Repair","volume":"7","author":"Augello M.","year":"2017","journal-title":"Clinical Practice"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/j.jacc.2018.07.069","article-title":"Mitral Annulus Disjunction: Emerging Role of Myocardial Mechanical Stretch in Arrhythmogenesis","volume":"72","author":"Basso C.","year":"2018","journal-title":"Journal of the American College of Cardiology"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1161\/CIRCULATIONAHA.115.016291","article-title":"Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death","volume":"132","author":"Basso C.","year":"2015","journal-title":"Circulation"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1111\/echo.14437","article-title":"Mitral Annular Disjunction: A Systematic Review of the Literature","volume":"36","author":"Bennett S.","year":"2019","journal-title":"Echocardiography"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcdd10040181","article-title":"Left Ventricle Segmental Longitudinal Strain and Regional Myocardial Work Index Could Help Determine Mitral Valve Prolapse Patients With Increased Risk of Ventricular Arrhythmias","volume":"10","author":"Dani\u0142owicz\u2010Szymanowicz L.","year":"2023","journal-title":"Journal of Cardiovascular Development and Disease"},{"issue":"14","key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.jacc.2018.07.070","article-title":"The Mitral Annulus Disjunction Arrhythmic Syndrome","volume":"72","author":"Dejgaard L. 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