A little innocent heart murmur in a child with accessory mitral valve tissue

Abstract

Accessory mitral valve tissue (AMVT) is a very rare congenital malformation and its incidence is unknown. In adult it was reported that 1 case every 26,000 performed echocardiograms. It may be alone or associated with other abnormalities of the heart [ 1 Rovner A. Thanigaraj S. Perez J.E. Accessory mitral valve in an adult population: the role of echocardiography in diagnosis and management. J. Am. Soc. Echocardiogr. 2005; 18: 494-498https://doi.org/10.1016/j.echo.2005.01.027 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar , 2 Marie-Philippe V. Christophe J. Nicolas V.V. Luc-Philippe C. Left ventricular outflow tract obstruction secondary to accessory mitral valve tissue: a multimodality imaging approach. Eur. Heart J. 2014 Dec 21; 35: 3464 Crossref PubMed Scopus (3) Google Scholar , 3 Chandra D. Gupta A. Gupta V.K. Accessory mitral tissue: a rare cause of left ventricular outflow obstruction. Asian Cardiovasc. Thorac. Ann. 2014 Sep; 22: 878 Crossref PubMed Scopus (2) Google Scholar , 4 Bezgin T. Elveran A. Karagöz A. Çanga Y. Yılmaz F. Mitral valve with a single leaflet. Turk Kardiyol. Dern. Ars. 2014 Jan; 42: 80-82 Crossref PubMed Scopus (7) Google Scholar , 5 Dattilo G. Lamari A. Tulino V. Scarano M. De Luca E. Mutone D. et al. Congenital valvular heart disease with high familial penetrance. Recenti Prog. Med. 2012 Dec; 103: 581-583https://doi.org/10.1701/1206.13361 Crossref PubMed Scopus (25) Google Scholar , 6 Tulino V. Cacace C. Tulino E. Imbalzano E. Dattilo G. Clinical variants in Ebstein's anomaly. Int. J. Cardiol. 2013 Oct 12; 168: 4969-4970https://doi.org/10.1016/j.ijcard.2013.07.138 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 7 Isobe M. Tanaka M. Sekiguchi M. Subaortic stenosis due to accessory tissue of the mitral valve associated with Ebstein's anomaly in an adult. Int. J. Cardiol. 1996 Dec 13; 57: 286-288 Abstract Full Text PDF PubMed Scopus (12) Google Scholar ]. We present a case of a 6 years old patient, sent to cardiac evaluation because of the presence of a heart murmur at the upper left sternal border, previously considered of little importance. He was born from a diabetic smoker mother. An ECG was performed resulting normal. Transthoracic echocardiogram showed a floating ovoid mass below the aortic valve (Fig. 1A ). CW Doppler showed a pressure gradient through the left ventricle outflow tract with a peak velocity of 2.5 m/s. There was a thick tendon between the interventricular septum and the mass (Fig. 1B). The mass was surgically resected and the final diagnosis was accessory mitral valve leaflet (Fig. 1C) [ 8 Imbalzano E. Di Bella G. Lamari A. Scarano M. Casale M. Busacca P. et al. Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D strain and traditional parameters. J. Exp. Clin. Cardiol. 2014; 20: 2729-2743 Google Scholar , 9 Uysal O.K. Duran M. Ozkan B. Tekin K. Elbasan Z. Asymptomatic accessory mitral valve tissue diagnosed by echocardiography. Korean Circ. J. 2012 Nov; 42: 800https://doi.org/10.4070/kcj.2012.42.11.800 Crossref PubMed Scopus (7) Google Scholar , 10 Mandraffino G. Sardo M.A. Riggio S. D'Ascola A. Loddo S. Alibrandi A. et al. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin. Biochem. 2010 Dec; 43: 1436-1442https://doi.org/10.1016/j.clinbiochem.2010.09.023 Crossref PubMed Scopus (40) Google Scholar , 11 Dattilo G. Lamari A. Scarano M. Di Bella G. Imbalzano E. Busacca P. et al. Coronary artery disease and psoriasis. Minerva Cardioangiol. 2014 Feb; 62: 119-121 PubMed Google Scholar , 12 Mathias H. Ismail Y. Hamilton M.C. Manghat N.E. Accessory mitral valve tissue: appearance on cardiac computed tomography. J. Cardiovasc. Comput. Tomogr. 2012 Nov–Dec; 6: 429-430https://doi.org/10.1016/j.jcct.2012.11.001 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 13 Dattilo G. Lamari A. Messina F. Imbalzano E. Salamone I. Carerj S. et al. The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of valsalva. Int. J. Cardiol. 2011 Jun 2; 149: e43-e46https://doi.org/10.1016/j.ijcard.2009.03.093 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 14 Yamaguchi S. Ishikawa N. Tomita S. Ohtake H. Kiuchi R. Nishida Y. et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann. Thorac. Surg. 2014 Sep; 98: 1096-1098 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 15 Laganà P. Melcarne L. Delia S. Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance. Int. J. Cardiol. 2015 May 6; 187: 678-679https://doi.org/10.1016/j.ijcard.2015.04.019 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ].