Accessory Miniature Mitral Valve Causing Subaortic Obstruction

Abstract

We have read the article by Ahmed El-Eshmawi and colleagues [1El-Eshmawi A. Castillo J.G. Rhee A.J. Pawale A. Anyanwu A.C. Accessory mitral valve leaflet.Ann Thorac Surg. 2014; 98: 344Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar] titled “Accessory mitral valve leaflet” with great interest. Accessory mitral tissue is one of the rare lesions that may cause left ventricular outflow tract obstruction (LVOTO). We have seen an extremely rare lesion an “accessory miniature mitral valve” leading to severe obstruction at the left ventricular outflow tract (LVOT) in a 4-year-old boy (Fig 1A). This accessory miniature mitral valve had two separate leaflets, chordae, and papillary muscles (Fig 1C). At the operation, excision of the accessory miniature mitral valve was performed through the aortic valve. Before the excision we examined the native mitral valve, through the right atrial and interatrial approach, to avoid damage to the native mitral valve apparatus (Fig 1B). Transesophageal echocardiography after the patient was weaned from cardiopulmonary bypass revealed no residual LVOTO and normal aortic and mitral valve function (Fig 1A). On this occasion, we wish to share this extremely rare case of accessory miniature mitral valve causing LVOTO because we have not seen any similar case in the literature. Accessory Mitral Valve LeafletThe Annals of Thoracic SurgeryVol. 98Issue 1PreviewAn 89-year-old-man with severe symptomatic aortic stenosis was found to have an accessory mitral valve leaflet causing systolic anterior motion on the preoperative echocardiogram. Intraoperative transesophageal echocardiography showed the presence of a 2-cm long and 0.4-cm thick membranelike structure (accessory mitral leaflet) attached to the ventricular side of the anterior mitral leaflet (Figs 1A-1C; Ao = aorta, LA = left atrium, MV = mitral valve). The accessory mitral leaflet projected into the left ventricular outflow tract during the peak of systole (Fig 1D). Full-Text PDF ReplyThe Annals of Thoracic SurgeryVol. 99Issue 5PreviewWe congratulate Sarioğlu and colleagues [1] for their successfully managed case of an accessory miniature mitral valve (AMMV) causing left ventricle outflow tract obstruction (LVOTO) in a 4-year-old child. Full-Text PDF