Abstract
IntroductionThe anterior mitral leaflet cleft is an unusual congenital lesion most often encountered in association with other congenital heart defects. The isolated anterior leaflet cleft is quite a rare anomaly and is usually cause of mitral valve regurgitation. The importance of the lesion is that it is often correctable. When feasible, cleft suture and, eventually, annuloplasty are preferable to valve replacement. Echocardiography is the first choice technique in the evaluation of mitral valve disease, providing useful information about valve anatomy and hemodynamic parameters.Case presentationWe present a case of an isolated anterior mitral leaflet cleft producing moderate-severe mitral regurgitation correctly identified by echocardiography and successfully surgically corrected.ConclusionIsolated cleft is a rare aberration, that has to be known in order to be diagnosed. Transthoracic and transesophageal echocardiography is the most useful non invasive technique for cleft diagnosis and to indicate the right surgical correction.
Highlights
The anterior mitral leaflet cleft is an unusual congenital lesion most often encountered in association with other congenital heart defects
Case presentation: We present a case of an isolated anterior mitral leaflet cleft producing moderate-severe mitral regurgitation correctly identified by echocardiography and successfully surgically corrected
The isolated anterior leaflet cleft is quite a rare anomaly, in which some anatomic data are specific: unlike endocardial cushion defect, mitral annulus is in normal position, cleft pointed towards left ventricular outflow tract, mitral and tricuspid valves are, as in normal subject, attached to the interventricular septum at different levels [1]
Summary
The anterior mitral leaflet cleft is an unusual congenital lesion first described in 1954 [1]. We here present a clinical case of isolated anterior mitral leaflet cleft producing moderate-severe mitral regurgitation correctly identified by echocardiography. A previous transthoracic echocardiography (TTE) had revealed a dysplastic mitral valve with moderate regurgitation (eccentric jet towards left atrium lateral wall), a mild left ventricle enlargement (end-diastolic diameter 57 mm, end-systolic diameter 38 mm) with a conserved systolic function (LVEF 70%), an intact interatrial septum, and normal systolic pulmonary artery pressure. TTE and TEE, performed in our echolab confirmed mitral dysplasia and P2 prolapse but showed mitral anterior leaflet cleft, mitral annulus dilatation and moderate-severe MR with a holosystolic jet originating centrally and directed towards lateral wall of the left atrium (jet area 10 cm, jet/left atrium ratio 0,52) (Figs 1,2). The patient was addressed to surgery and underwent mitral valve repair, with directed cleft suture and posterior ring annuloplasty.
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