Isolated cleft of the posterior mitral valve leaflet

Abstract

Fig. 1. A: Late-systolic still-frame of a transthoracic short axis view depicts the cleft (⁎) of the mildly thickened posterior mitral leaflet. AML denotes anterior mitral leaflet. B: Colour Doppler showing a moderate mitral regurgitation. A 64-year-old lady was referred for evaluation of a recently detected heart murmur. The patient was completely asymptomatic and an avid tennis player. Auscultation revealed a loud midto late systolic click followed by a grade III midto late systolic regurgitant murmur. Transthoracic echocardiography showed an isolated cleft of the mildly thickened posterior mitral valve leaflet with a moderate late systolic mitral regurgitation (Fig. 1). The anterior mitral valve leaflet and the subvalvular apparatus were normal, especially the insertion of the papillary muscles. No other cardiac anomalies were present. Isolated cleft posterior mitral valve leaflet is a very rare congenital malformation that is usually diagnosed in early childhood. The cleft is more commonly found in the anterior leaflet and in association with other cardiac anomalies such as atrioventricular septal defects and anomalies of the papillary muscles [1,2]. A retrospective analysis of more than 13,000 children revealed only ten isolated cleft mitral valve leaflets with none of them affecting the posterior leaflet [3]. Cleft mitral valve leaflet may result in severe mitral regurgitation and the need for surgical repair [4]. Our patient was diagnosed with the malformation at age sixty-four, had only moderate mitral regurgitation and remained asymptomatic.