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Response to: 'Size of the shadow'
  1. Valentina Mantegazza,
  2. Valentina Volpato,
  3. Paola Gripari,
  4. Sarah Ghulam Ali,
  5. Laura Fusini,
  6. Gianpiero Italiano,
  7. Manuela Muratori,
  8. Gianluca Pontone,
  9. Gloria Tamborini,
  10. Mauro Pepi
  1. Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milano, Italy
  1. Correspondence to Dr Valentina Mantegazza, Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy; valentina.mantegazza{at}

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The Authors' reply

We thank Dr Garbi and colleagues1 for their interest in our recently published study.2 The authors underline that mitral annular disjunction (MAD) cannot be considered a risk factor for sudden cardiac death in mitral valve prolapse (MVP), as it is a widespread anatomical variation of the mitral valve annulus (MVA), also described in histological specimens of hearts without MVP. We agree that the link between MAD and malignant MVP is still speculative, as several factors may be responsible for ventricular arrhythmias, including genetic, structural, mechanical …

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  • Collaborators None.

  • Contributors All authors contributed to this reply.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests VV is on speaker bureau for Philips Healthcare. GP reports research grants and/or honorarium as speaker from GE Healthcare, Bracco, Bayer, Medtronic and Heartflow.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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  • Correspondence
    Madalina Garbi Francis Wells Jonathan Weirmccall Robert H Anderson