{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T21:33:57Z","timestamp":1777239237332,"version":"3.51.4"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pronounced mitral annular disjunction (pMAD \u22658 mm) in myxomatous mitral valve disease has been associated with ventricular arrhythmias in selected cohorts, whereas minor degrees of mural separation are frequently observed in structurally normal hearts. Its clinical relevance after mitral valve surgery remains unclear. We investigated whether pMAD is associated with postoperative symptom burden and rhythm outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodsv<\/jats:title>\n                    <jats:p>In this retrospective cohort with prospective follow-up, 246 adults undergoing mitral valve surgery for Barlow\u2019s disease were classified intraoperatively as pMAD (\u22658 mm) or non-pMAD (&amp;lt;8 mm). The primary end point was patient-reported postoperative palpitations. Propensity score\u2013based inverse probability weighting was applied to adjust for baseline differences. Structured follow-up in pMAD patients included transthoracic echocardiography (TTE) and 24-hour Holter monitoring.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>pMAD was present in 103 patients (41.9%). Surgery effectively reduced disjunction distance. At follow-up, palpitations were more frequent in pMAD compared with non-pMAD patients (40.8% vs 18.9%, P\u2009=\u2009.011), remaining significant after adjustment. In the pMAD follow-up cohort, atrial fibrillation prevalence decreased significantly after surgery. Holter monitoring did not demonstrate sustained malignant arrhythmias. Survival and major adverse events were comparable between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>After mitral valve surgery for Barlow\u2019s disease, pMAD is independently associated with increased postoperative palpitations despite anatomical correction. This association was not accompanied by excess malignant arrhythmias or adverse clinical end points, suggesting persistent symptom susceptibility rather than overt electrical instability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/icvts\/ivag104","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T11:49:25Z","timestamp":1775735365000},"source":"Crossref","is-referenced-by-count":0,"title":["Pronounced Mitral Annular Disjunction Is Associated With Increased Postoperative Palpitations After Mitral Valve Surgery for Barlow\u2019s Disease"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1489-0524","authenticated-orcid":false,"given":"Martin","family":"Bichler","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8308-7679","authenticated-orcid":false,"given":"Keti","family":"Vitanova","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4413-8402","authenticated-orcid":false,"given":"Nina","family":"Feirer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gertrud","family":"Goppel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9993-8508","authenticated-orcid":false,"given":"Karin","family":"Steiner","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5466-9290","authenticated-orcid":false,"given":"Markus","family":"Krane","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5191-0360","authenticated-orcid":false,"given":"Johannes","family":"Boehm","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Institute INSURE, TUM University Hospital German Heart Center, TUM School of Medicine and Health, Technical University of Munich (TUM), German Heart Center , Lazarettstra\u00dfe 36 , 80636 Munich, Bavaria,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"2026042616415540900_ivag104-B1","doi-asserted-by":"publisher","first-page":"1014","DOI":"10.1016\/j.echo.2005.06.013","article-title":"Mitral annular disjunction in advanced myxomatous mitral valve disease: echocardiographic detection and surgical correction","volume":"18","author":"Eriksson","year":"2005","journal-title":"J Am Soc Echocardiogr"},{"key":"2026042616415540900_ivag104-B2","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1161\/CIRCULATIONAHA.115.016291","article-title":"Arrhythmic mitral valve prolapse and sudden cardiac death","volume":"132","author":"Basso","year":"2015","journal-title":"Circulation"},{"key":"2026042616415540900_ivag104-B3","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1016\/j.jacc.2018.07.070","article-title":"The mitral annulus disjunction arrhythmic syndrome","volume":"72","author":"Dejgaard","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026042616415540900_ivag104-B4","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1016\/j.jcmg.2021.04.029","article-title":"The mitral annular disjunction of mitral valve prolapse: presentation and outcome","volume":"14","author":"Essayagh","year":"2021","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026042616415540900_ivag104-B5","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1136\/heartjnl-2020-317330","article-title":"Multimodality imaging assessment of mitral annular disjunction in mitral valve prolapse","volume":"107","author":"Mantegazza","year":"2021","journal-title":"Heart"},{"issue":"5","key":"2026042616415540900_ivag104-B6","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.3390\/jcm14051423","article-title":"The prevalence, pathophysiological role and determinants of mitral annular disjunction among patients with mitral valve prolapse: A systematic review","volume":"14","author":"Sonaglioni","year":"2025","journal-title":"JCM"},{"key":"2026042616415540900_ivag104-B7","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1093\/ehjci\/jeab022","article-title":"Prevalence and extent of mitral annular disjunction in structurally normal hearts: comprehensive 3D analysis using cardiac computed tomography","volume":"22","author":"Toh","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026042616415540900_ivag104-B8","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1111\/j.0886-0440.2004.04076.x","article-title":"Atrial remodeling after mitral valve surgery in patients with permanent atrial fibrillation","volume":"19","author":"Hornero","year":"2004","journal-title":"J Card Surg"},{"key":"2026042616415540900_ivag104-B9","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/1476-7120-8-53","article-title":"Mitral annular disjunction in myxomatous mitral valve disease: a relevant abnormality recognizable by transthoracic echocardiography","volume":"8","author":"Carmo","year":"2010","journal-title":"Cardiovasc Ultrasound"},{"key":"2026042616415540900_ivag104-B10","doi-asserted-by":"publisher","first-page":"e010584","DOI":"10.1161\/JAHA.118.010584","article-title":"Mitral valve prolapse and sudden cardiac death: a systematic review","volume":"7","author":"Han","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2026042616415540900_ivag104-B11","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1016\/j.jtcvs.2008.10.026","article-title":"Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse","volume":"137","author":"Suri","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042616415540900_ivag104-B12","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/s0002-9343(97)89451-x","article-title":"Evaluation and outcomes of patients with palpitations","volume":"100","author":"Weber","year":"1996","journal-title":"Am J Med"},{"key":"2026042616415540900_ivag104-B13","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1136\/heartjnl-2020-317451","article-title":"Parameters associated with ventricular arrhythmias in mitral valve prolapse with significant regurgitation","volume":"107","author":"van Wijngaarden","year":"2021","journal-title":"Heart"},{"key":"2026042616415540900_ivag104-B14","doi-asserted-by":"publisher","first-page":"421","DOI":"10.14740\/cr1584","article-title":"Mitral annular disjunction: clinical implications and surgical considerations","volume":"14","author":"Zhu","year":"2023","journal-title":"Cardiol Res"},{"key":"2026042616415540900_ivag104-B15","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.case.2022.12.004","article-title":"Stop the madness: mitral annular disjunction","volume":"7","author":"Chess","year":"2023","journal-title":"CASE (Phila)"},{"key":"2026042616415540900_ivag104-B16","doi-asserted-by":"publisher","first-page":"117","DOI":"10.31083\/j.rcm2304117","article-title":"Mitral annular disjunction: pathophysiology, pro-arrhythmic profile and repair pearls","volume":"23","author":"Karangelis","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"2026042616415540900_ivag104-B17","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/CRD.0000000000000594","article-title":"Mitral annular disjunction: a scoping review","volume":"33","author":"Gupta","year":"2025","journal-title":"Cardiol Rev"},{"key":"2026042616415540900_ivag104-B18","doi-asserted-by":"publisher","first-page":"e11","DOI":"10.15420\/aer.2023.26","article-title":"Arrhythmogenic mitral valve prolapse: can we risk stratify and prevent sudden cardiac death?","volume":"13","author":"Cameron","year":"2024","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2026042616415540900_ivag104-B19","doi-asserted-by":"publisher","first-page":"e70211","DOI":"10.1111\/echo.70211","article-title":"Complex ventricular arrhythmias in patients with mitral annular disjunction: a systematic review and meta-analysis","volume":"42","author":"Gon\u00e7alves","year":"2025","journal-title":"Echocardiography"},{"key":"2026042616415540900_ivag104-B20","doi-asserted-by":"publisher","first-page":"e005030","DOI":"10.1161\/CIRCIMAGING.116.005030","article-title":"Morphofunctional abnormalities of mitral annulus and arrhythmic mitral valve prolapse","volume":"9","author":"Perazzolo Marra","year":"2016","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026042616415540900_ivag104-B21","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1136\/heartjnl-2017-312932","article-title":"Mitral valve prolapse and sudden cardiac death: a systematic review and meta-analysis","volume":"105","author":"Nalliah","year":"2019","journal-title":"Heart"},{"key":"2026042616415540900_ivag104-B22","doi-asserted-by":"publisher","first-page":"2904","DOI":"10.1016\/j.jacc.2018.09.048","article-title":"Arrhythmic mitral valve prolapse: JACC review topic of the week","volume":"72","author":"Miller","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026042616415540900_ivag104-B23","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s10554-009-9514-6","article-title":"Predictors of ventricular arrhythmias in patients with mitral valve prolapse","volume":"26","author":"Turker","year":"2010","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026042616415540900_ivag104-B24","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/j.jacc.2020.06.029","article-title":"Presentation and outcome of arrhythmic mitral valve prolapse","volume":"76","author":"Essayagh","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026042616415540900_ivag104-B25","doi-asserted-by":"publisher","first-page":"e014243","DOI":"10.1161\/CIRCIMAGING.122.014243","article-title":"Imaging considerations and clinical implications of mitral annular disjunction","volume":"15","author":"Drescher","year":"2022","journal-title":"Circ: Cardiovas Imaging"},{"key":"2026042616415540900_ivag104-B26","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1161\/CIRCULATIONAHA.118.034075","article-title":"Mitral valve prolapse, ventricular arrhythmias, and sudden death","volume":"140","author":"Basso","year":"2019","journal-title":"Circulation"},{"key":"2026042616415540900_ivag104-B27","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/s44156-023-00032-x","article-title":"Mitral annular disjunction in surgical mitral valve prolapse: prevalence, characteristics and outcomes","volume":"10","author":"Gray","year":"2023","journal-title":"Echo Res Pract"},{"key":"2026042616415540900_ivag104-B28","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1148\/radiol.220454","article-title":"Myocardial fibrosis at cardiac MRI helps predict adverse clinical outcome in patients with mitral valve prolapse","volume":"306","author":"Figliozzi","year":"2023","journal-title":"Radiology"},{"key":"2026042616415540900_ivag104-B29","doi-asserted-by":"publisher","first-page":"135","DOI":"10.21037\/acs-2023-afm-0208","article-title":"Surgical options for atrial fibrillation treatment during concomitant cardiac procedures","volume":"13","author":"Baudo","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"key":"2026042616415540900_ivag104-B30","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1016\/j.jtcvs.2017.09.147","article-title":"Long-term outcome following concomitant mitral valve surgery and cox maze procedure for atrial fibrillation","volume":"155","author":"Ad","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042616415540900_ivag104-B31","doi-asserted-by":"publisher","first-page":"2868","DOI":"10.3390\/diagnostics13182868","article-title":"Arrhythmic mitral valve prolapse: a comprehensive review","volume":"13","author":"Deng","year":"2023","journal-title":"Diagnostics"},{"key":"2026042616415540900_ivag104-B32","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.athoracsur.2007.04.036","article-title":"Influence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified?","volume":"84","author":"Ngaage","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2026042616415540900_ivag104-B33","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.echo.2021.09.004","article-title":"Mitral annular disjunction of degenerative mitral regurgitation: three-dimensional evaluation and implications for mitral repair","volume":"35","author":"Essayagh","year":"2022","journal-title":"J Am Soc Echocardiogr"},{"key":"2026042616415540900_ivag104-B34","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf029","article-title":"Outcomes of patients with mitral annular disjunction undergoing mitral valve repair\u2020","volume":"67","author":"Muneretto","year":"2025","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026042616415540900_ivag104-B35","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.1016\/j.athoracsur.2009.08.008","article-title":"Mitral valve repair for degenerative disease: a 20-year experience","volume":"88","author":"Daneshmand","year":"2009","journal-title":"Ann Thorac Surg"},{"key":"2026042616415540900_ivag104-B36","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1016\/S1010-7940(01)00952-6","article-title":"A prospective study of changes in the quality of life of patients following mitral valve repair and replacement","volume":"20","author":"Goldsmith","year":"2001","journal-title":"Eur J Cardiothorac Surg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivag104\/68024752\/ivag104.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/4\/ivag104\/68024752\/ivag104.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/4\/ivag104\/68024752\/ivag104.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T20:42:05Z","timestamp":1777236125000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivag104\/8651110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivag104","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,4,1]]},"article-number":"ivag104"}}