Parachute-like asymmetric mitral valve in an adult – An extremely rare presentation

Abstract

A parachute mitral valve (PMV) is a congenital condition characterised by the unifocal attachment of the mitral valve chordae tendinae irrespective of the number of papillary muscles. The PMV complex is known to occur in two forms, the true PMV and the parachute-like asymmetric mitral valve.This classification is based on morphological features seen on trans-thoracic echocardiography (ECHO), where in the true form of the PMV, a single papillary muscle receives all chordae tendinae, which attaches to the left ventricular wall. The parachute-like asymmetric variant has two papillary muscles: one is elongated and located higher in the left ventricle, which was seen in our case. Our patient was a 21-year-old female who presented to us with a long standing history of severe breathlessness that had developed gradually over the last few years; an ECHO revealed a parachute-like asymmetric mitral valve associated with severe mitral regurgitation. She successfully underwent mitral valve replacement, which resulted in resolution of her symptoms. PMV disease is a very rare presentation, especially in adults with very few cases reported in the past; we hope to encourage discussion with regards to congenital mitral valve anomalies whilst familiarizing clinicians with this unusual presentation.