Accessory Mitral Valve Leaflet Research Articles

A retrospective analysis of mitral valve pathology in the setting of bicuspid aortic valves

The therapeutic implications of bicuspid aortic valve associations have come under scrutiny in the transcatheter aortic valve implantation era. We evaluate the spectrum of mitral valve disease in patients with bicuspid aortic valves to determine the need for closer echocardiographic scrutiny/follow-up of the mitral valve. A retrospective analysis of echocardiograms done at a referral hospital over five years was conducted in patients with bicuspid aortic valves with special attention to congenital abnormalities of the mitral valve. One hundred and forty patients with a bicuspid aortic valve were included. A congenital mitral valve abnormality was present in eight (5.7%, P=0.01) with a parachute mitral valve in four (2.8%), an accessory mitral valve leaflet in one (0.7%), mitral valve prolapse in one, a cleft in one and the novel finding of a trileaflet mitral valve in one. Minor abnormalities included an elongated anterior mitral valve leaflet (P<0.001), the increased incidence of physiological mitral regurgitation (P<0.001), abnormal papillary muscles (P=0.002) and an additional chord or tendon in the left ventricle cavity (P=0.007). Mitral valve abnormalities occur more commonly in patients with bicuspid aortic valves than matched healthy individuals. The study confirms that abnormalities in these patients extend beyond the aorta. These abnormalities did not have a significant functional effect.

Accessory Mitral Valve Leaflet Causing Severe Left Ventricular Outflow Tract Obstruction in a Preterm Neonate with a Partial Atrioventricular Septal Defect

Atrioventricular septal defects represent a class of congenital cardiac malformations that vary in presentation and management strategy depending upon the severity of the particular lesions present. We present the case of a premature neonate who had a partial atrioventricular septal defect and an accessory mitral (or left atrioventricular) valve leaflet. The latter caused severe left ventricular outflow tract obstruction and severely depressed left ventricular function. We found only one other report of this atrioventricular valve abnormality in association with atrioventricular septal defect. To our knowledge, our patient (at a body weight of 1,800 g) is the smallest to survive corrective surgery of an accessory mitral valve leaflet with severe left ventricular outflow tract obstruction. In addition to our patient's case, we discuss the relevant medical literature.

Tri-leafl et mitral valves – when lightning strikes thrice

Mitral valves are well known to be bi-leaflet structures with attachments from both leaflets (anterior and posterior) to both papillary muscles (anterolateral and posteromedial). Congenital abnormalities of the mitral valve, although well described, are quite rare. These abnormalities can involve either the leaflet (cleft mitral valve) or the subvalvular apparatus (parachute mitral valve) or even occur as accessory mitral valve tissue (accessory mitral valve leaflet). These can occur in isolation, or in association with other congenital abnormalities. A tri-leaflet mitral valve is a novel echocardiographic finding that has only been described in 6 patients in 4 different case reports.(1-4) We report on 3 patients recently found to have trileaflet mitral valves in the setting of atrioventricular concordance and normal offset of the AV valves at our out-patient clinic.

A little innocent heart murmur in a child with accessory mitral valve tissue

Accessory mitral valve tissue (AMVT) is a very rare congenital malformation and its incidence is unknown. In adult it was reported that 1 case every 26,000 performed echocardiograms. It may be alone or associated with other abnormalities of the heart [ 1 Rovner A. Thanigaraj S. Perez J.E. Accessory mitral valve in an adult population: the role of echocardiography in diagnosis and management. J. Am. Soc. Echocardiogr. 2005; 18: 494-498https://doi.org/10.1016/j.echo.2005.01.027 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar , 2 Marie-Philippe V. Christophe J. Nicolas V.V. Luc-Philippe C. Left ventricular outflow tract obstruction secondary to accessory mitral valve tissue: a multimodality imaging approach. Eur. Heart J. 2014 Dec 21; 35: 3464 Crossref PubMed Scopus (3) Google Scholar , 3 Chandra D. Gupta A. Gupta V.K. Accessory mitral tissue: a rare cause of left ventricular outflow obstruction. Asian Cardiovasc. Thorac. Ann. 2014 Sep; 22: 878 Crossref PubMed Scopus (2) Google Scholar , 4 Bezgin T. Elveran A. Karagöz A. Çanga Y. Yılmaz F. Mitral valve with a single leaflet. Turk Kardiyol. Dern. Ars. 2014 Jan; 42: 80-82 Crossref PubMed Scopus (7) Google Scholar , 5 Dattilo G. Lamari A. Tulino V. Scarano M. De Luca E. Mutone D. et al. Congenital valvular heart disease with high familial penetrance. Recenti Prog. Med. 2012 Dec; 103: 581-583https://doi.org/10.1701/1206.13361 Crossref PubMed Scopus (25) Google Scholar , 6 Tulino V. Cacace C. Tulino E. Imbalzano E. Dattilo G. Clinical variants in Ebstein's anomaly. Int. J. Cardiol. 2013 Oct 12; 168: 4969-4970https://doi.org/10.1016/j.ijcard.2013.07.138 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 7 Isobe M. Tanaka M. Sekiguchi M. Subaortic stenosis due to accessory tissue of the mitral valve associated with Ebstein's anomaly in an adult. Int. J. Cardiol. 1996 Dec 13; 57: 286-288 Abstract Full Text PDF PubMed Scopus (12) Google Scholar ]. We present a case of a 6 years old patient, sent to cardiac evaluation because of the presence of a heart murmur at the upper left sternal border, previously considered of little importance. He was born from a diabetic smoker mother. An ECG was performed resulting normal. Transthoracic echocardiogram showed a floating ovoid mass below the aortic valve (Fig. 1A ). CW Doppler showed a pressure gradient through the left ventricle outflow tract with a peak velocity of 2.5 m/s. There was a thick tendon between the interventricular septum and the mass (Fig. 1B). The mass was surgically resected and the final diagnosis was accessory mitral valve leaflet (Fig. 1C) [ 8 Imbalzano E. Di Bella G. Lamari A. Scarano M. Casale M. Busacca P. et al. Right ventricular myocardial deformation in young healthy subjects: a comparison study between 2D strain and traditional parameters. J. Exp. Clin. Cardiol. 2014; 20: 2729-2743 Google Scholar , 9 Uysal O.K. Duran M. Ozkan B. Tekin K. Elbasan Z. Asymptomatic accessory mitral valve tissue diagnosed by echocardiography. Korean Circ. J. 2012 Nov; 42: 800https://doi.org/10.4070/kcj.2012.42.11.800 Crossref PubMed Scopus (7) Google Scholar , 10 Mandraffino G. Sardo M.A. Riggio S. D'Ascola A. Loddo S. Alibrandi A. et al. Smoke exposure and circulating progenitor cells: evidence for modulation of antioxidant enzymes and cell count. Clin. Biochem. 2010 Dec; 43: 1436-1442https://doi.org/10.1016/j.clinbiochem.2010.09.023 Crossref PubMed Scopus (40) Google Scholar , 11 Dattilo G. Lamari A. Scarano M. Di Bella G. Imbalzano E. Busacca P. et al. Coronary artery disease and psoriasis. Minerva Cardioangiol. 2014 Feb; 62: 119-121 PubMed Google Scholar , 12 Mathias H. Ismail Y. Hamilton M.C. Manghat N.E. Accessory mitral valve tissue: appearance on cardiac computed tomography. J. Cardiovasc. Comput. Tomogr. 2012 Nov–Dec; 6: 429-430https://doi.org/10.1016/j.jcct.2012.11.001 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 13 Dattilo G. Lamari A. Messina F. Imbalzano E. Salamone I. Carerj S. et al. The chance finding at multislice computed tomography coronary angiography of an ectopic origin of the left circumflex coronary artery from the right sinus of valsalva. Int. J. Cardiol. 2011 Jun 2; 149: e43-e46https://doi.org/10.1016/j.ijcard.2009.03.093 Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar , 14 Yamaguchi S. Ishikawa N. Tomita S. Ohtake H. Kiuchi R. Nishida Y. et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann. Thorac. Surg. 2014 Sep; 98: 1096-1098 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 15 Laganà P. Melcarne L. Delia S. Acinetobacter baumannii and endocarditis, rare complication but important clinical relevance. Int. J. Cardiol. 2015 May 6; 187: 678-679https://doi.org/10.1016/j.ijcard.2015.04.019 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ].

An Accessory Mitral Valve Leaflet Causing Left Ventricular Outflow Tract Obstruction and Associated with Severe Aortic Incompetence

This case report describes a 20-year-old woman with Turner's syndrome who presented with reduced effort tolerance limited by dyspnea. She had previously been on pediatric cardiology follow-up for congenital subvalvular aortic stenosis first diagnosed at age 7. Unfortunately she defaulted after two visits before any intervention could be done. Transthoracic echocardiography demonstrated severe aortic incompetence (AI) with a membrane-like structure in the left ventricular outflow tract (LVOT). The mean pressure gradient across the LVOT on continuous wave Doppler was 41 mmHg. The membranous interventricular septum appeared aneurysmal and it was observed that the "subaortic membrane" had a connection to the anterolateral papillary muscle via a strand of chordal tissue. Further images were captured using two-dimensional and three-dimensional transthoracic and transesophageal echocardiography (iE33, Philips Medical Systems, Andover, MA, USA). After a review of the literature it was concluded that this appeared to be an accessory mitral valve (AMV) leaflet causing LVOT obstruction associated with AI. AMV tissue is a rare congenital malformation causing LVOT obstruction. Because it is so unusual, it may not be immediately recognizable even in a high volume echocardiography laboratory. The clue which helped with the diagnosis was the strand of chordal tissue which connected the mass to the papillary muscle. This anomaly is often associated with LVOT obstruction.

Accessory mitral valve leaflet causing left ventricular outflow tract obstruction in an adult

A 44-year-old man was referred for echo because of an asymptomatic murmur. This showed a gradient of 90 mm Hg in the left ventricular outflow tract (LVOT) with suggestion of...