Direct insertion of papillary muscle into mitral valve leaflets in a healthy patient without hypertrophic cardiomyopathy

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We present the case of a healthy young woman that was evaluated before participation in amateur sports. A systolic and diastolic murmur was heard during the physical examination. Two-dimensional echocardiography was performed, and a direct insertion of the posteromedial papillary muscle into the mitral valve leaflets was found. Mild mitral stenosis and moderate regurgitation were also found. Because she was asymptomatic, a follow-up in 6months was planned to control the evaluation of her valve disease.