Abstract
BackgroundA mitral cleft may be an important etiological factor for significant mitral regurgitation. We diagnose an additional cleft mitral valve by a combination of 2-dimensional (2-D) and 3-dimensional (3-D) echocardiography.Case presentationWe describe the case of a severe mitral regurgitation due to posterior leaflet prolapse (P2). In the 2-D view, which is obtained after turning the probe clockwise from the mid-esophageal long-axis view, TEE showed a moderate central regurgitation jet. In the 3-D en face view, a cleft between P2 and P3 was identified, and we found that the cause of mitral regurgitation was not only P2 prolapse but also a cleft between P2 and P3.ConclusionA complex mitral valve lesion was detected by a combination of 2-D and 3-D TEE. The presence of a cleft could affect the surgical procedure because of the possibility that an enlarged cleft would increase with leaflet resection.
Highlights
A mitral cleft may be an important etiological factor for significant mitral regurgitation
We found out two important clinical issues: firstly, intraoperative transesophageal echocardiography (TEE), which is a combination of 2-D and 3-D echocardiography, was useful for diagnosing mitral regurgitation due to a cleft between P2 and P3 with P2 prolapse
It was more useful for the selection of the mitral valve repair procedure by diagnosing the complicated mitral valve lesion which recognized the mitral regurgitation from the cleft
Summary
A mitral cleft may be an important etiological factor for significant mitral regurgitation. Anesthesia was maintained with 1.5% of sevoflurane in oxygen, continuous infusions of 0.2‐0.4 μg/kg/min of remifentanil, and 4 mg/kg/h of propofol. TEE showed posterior leaflet prolapse (P2) with a marked eccentric jet in the mid-esophageal long-axis view (Fig. 1). After turning the probe clockwise from the mid-esophageal long-axis view, TEE showed a moderate
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