Accessory Mitral Valve Tissue Research Articles

Accessory mitral valve tissue causing left ventricular outflow obstruction

Accessory mitral valve tissue causing left ventricular outflow obstruction

Multimodal Imaging for the Diagnosis of Accessory Mitral Valve Tissue

Multimodal Imaging for the Diagnosis of Accessory Mitral Valve Tissue

Accessory mitral valve tissue: a differential diagnosis of an obstructive mass on the left ventricular outflow tract.

Accessory mitral valve tissue is a rare congenital cardiac anomaly that is typically discovered incidentally during echocardiographic evaluation prompted by an asymptomatic murmur. This pathology has characteristic echocardiographic elements and is usually associated with other CHD. The decision to perform surgical resection depends on factors such as the degree of obstruction, presence of symptoms, presence of other CHDs, and risk of thrombosis. The researchers hereby present a case of an asymptomatic paediatric patient with accessory mitral valve tissue that produced left ventricular outflow tract obstruction.

ДОПОЛНИТЕЛЬНАЯ ТКАНЬ МИТРАЛЬНОГО КЛАПАНА В ПРАКТИКЕ ТЕРАПЕВТА

Attention to the topic of accessory mitral valve tissue intense in the 90s. After that, it would seem that interest began to fade, however, at present it has begun to increase again according the number of reviews found in MedLine. ‘What is the reason for the increased interest’, ‘what is the current state of art’ these questions were the background for this review. This lecture summarizes new knowledge about mitral valve accessory tissue and makes it clear that it is important to physicians in many specialties including internists.

Abstract 12352: Left Ventricular Chordal Aberrancy: The Case of a Friend Turned Foe

Introduction: Aberrant cardiac structures reported on echocardiography include aberrant papillary muscles, accessory chordae tendineae, ventricular bands, and accessory mitral valve tissue. These usually present with conduction abnormality, obstruction, and heart failure. We report a diagnostic dilemma with a structurally anomalous chord noted on the echocardiogram presenting as recurrent stroke. Case: A 70 year old man presented with complaints of left facial droop, confusion and slurred speech, currently on aspirin and clopidogrel. CT head and MRI brain revealed right middle cerebral artery occlusion and acute on chronic infarcts in multiple vascular territories. Past medical history of recurrent strokes involving the right frontal, occipital lobes, and thalamus suggested embolic aetiology. Transthoracic and Transesophageal Echocardiographic (TEE) examination revealed an anomalous redundant chordal tissue attached to the papillary muscle with no distal attachment, normal mitral valve function without left ventricular outflow tract obstruction. This anomalous chord was present on TEE done 1 year prior but not well visualised at that time. Differentials included ruptured aberrant ventricular band, ruptured chordae tendineae, ruptured papillary muscle with a thrombus or vegetation formation. Due to the chronicity of the condition and negative blood cultures, vegetation was less likely. Recurrent mural thrombus associated with the aberrant chord was identified as the culprit and patient was started on anticoagulation to prevent stroke. Results: All of the aberrant structures reported in current literature have been characterized based on their distal attachment. We excluded accessory papillary muscle and chordae tendineae from the list of differentials as its rupture presents as mitral regurgitation and acute heart failure. The most plausible explanation includes a ruptured false tendon serving as a nidus for thrombus formation with no prior echocardiographic evidence of distal attachment of the fibrous chord. Conclusions: Our case illustrates a very rare entity of an idiopathic primary rupture of a left ventricle false tendon serving as a nidus for clot formation leading to recurrent stroke warranting anticoagulation.

Prenatal diagnosis of accessory mitral valve tissue in a fetus with persistent dysrhythmia

BackgroundAccessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly that mainly diagnosed in the first decade of life. However, asymptomatic cases may not be diagnosed even up to adulthood. We report a fetus with AMVT to show the diagnostic ability of the fetal echocardiography for detection of this pathology in the prenatal period.Case presentationAMVT was diagnosed in a 26-week-old male fetus with persistent dysrhythmia. Dysrhythmia could not be aborted and controlled by sotalol till the third trimester evaluation. Apical left ventricular (LV) diverticulum was the additional finding in his fetal echocardiogram. After birth, he was in sinus rhythm and echocardiography confirmed the presence of AMVT, however, without any evidence of LV apical diverticulum.ConclusionsThe diagnosis of AMVT in the prenatal period is possible by fetal echocardiography.

Accessory Mitral Valve Tissue and Internal Mammary Artery Stenosis: Unique Considerations After Cardiac Arrest

A man with recurrent syncope and remote aortic coarctation repair experienced cardiac arrest with exercise stress testing. Critical coronary stenosis was discovered. Further evaluation revealed accessory mitral valve tissue and internal mammary artery occlusion. These rare abnormalities, not previously reported together, presented challenges to treatment. (Level of Difficulty: Intermediate.)

Minimally Invasive Surgical Resection of Accessory Mitral Valve Tissue Causing Severe Symptomatic Left Ventricular Outflow Tract Obstruction in an Adult

Objective: We report a rare case of adult onset, symptomatic, severe left ventricular outflow tract obstruction secondary to accessory mitral valve tissue that was treated surgically through a minimally invasive partial sternotomy approach. Methods: A 29-year-old female with a previous diagnosis of a sub-aortic membrane with 6 months of progressive chest pain, fatigue, palpitations, and presyncope presented to the emergency department with acute onset of severe chest pain, left arm numbness, palpitations, and light-headedness. Transthoracic and subsequent transesophageal echocardiogram demonstrated a mobile, parachute-like mass in the left ventricular outflow track with severe outflow obstruction (resting velocity 3.9m/s and peak gradient 60mmHg). The patient was transferred to our institution for surgical evaluation. Results: Review of the echocardiographic imaging demonstrated obstructing accessory mitral valve tissue (Figure A). The patient underwent surgical resection of the obstructing mass through a partial upper-sternotomy. Accessory mitral valve tissue attached to the aorto-mitral curtain was removed en bloc with chordal attachments to the posteromedial papillary muscle and muscular interventricular septum (Figure C and D). A small, hemodynamically insignificant sub-aortic membrane was also excised. There was no residual gradient, and valvular and ventricular functions were preserved (Figure B). The patient was discharged home on postoperative day 3. Conclusions: While accessory mitral valve tissue rarely presents in adulthood it should remain part of the differential diagnosis of symptomatic left ventricular outflow tract obstruction. Early surgical intervention is recommended and may be performed safely via less invasive surgical approaches. Figure. Accessory mitral valve tissue causing symptomatic, severe left ventricular outflow tract obstruction before (A) and after (B) surgical resection though a minimally invasive partial sternotomy. (C) Surgeon’s view of the left ventricular outflow tract through the aortic valve of the accessory mitral valve tissue, with severed chordae tendinae, attached to the aorto-mitral curtain beneath the left/non-coronary commissure of the aortic valve. (D) Resected accessory mitral valve tissue

A Case of Double Chambered Left Ventricle with Accessory Mitral Valve Tissue

A Case of Double Chambered Left Ventricle with Accessory Mitral Valve Tissue

P838 Accessory Mitral Valve Tissue in a 35-year-ol female with Significant Left Ventricular Outflow Tract Obstruction and Aortic regurgitation

Abstract Accessory mitral valve tissue (AMVT) causing left ventricular outflow tract (LVOT) obstruction and aortic regurgitation is a rare congenital cardiac malformation.The true prevalence is not well known but latest literature review identified 104 cases of AMVT from 1963 to 2013. We present a case of asymptomatic 35-year-old female who came in due to heart murmur. Chest X-ray showed a right-sided aorta and a dilated ascending aorta. An echocardiographic finding of a mobile serpiginous AMVT that parachutes into LVOT with significant gradient of 74 mmhg. There was mild restriction of the aortic right coronary cusp with moderate aortic regurgitation and other finding noted of persistent left superior vena cava. The patient underwent open heart surgery and had an excision of the AMVT and subcommissuroplasty of the right coronary cusp. Histological analysis of the excised specimen showed fragments of valvular tissue with fibrosis. There was no obstruction on repeat echo with mild aortic regurgitation. No postoperative complication noted and was discharged stable. AMVT usually seen among young patients and it is uncommon among female adult population. LVOT obstruction and aortic regurgitation may caused by the AMVT. Echocardiography is an important modality in diagnosing and recognising such anomaly and the optimal treatment is surgery in the presence of significant LVOT obstruction. Abstract P838 Figure. Intraoperative findings

Accessory mitral valve tissue that caused a left ventricular outflow tract obstruction: a case report

BackgroundAccessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly and is usually diagnosed in childhood. The diagnosis of AMVT in adulthood is extremely rare. We present a case report on an adult patient with AMVT that caused a left ventricular outflow tract (LVOT) obstruction.Case presentationA 51-year-old man was diagnosed with AMVT via transesophageal echocardiography, which resulted in an LVOT occlusion (mean gradient 12 mmHg) during systole. Resection of the AMVT was performed under general anesthesia. The patient was hemodynamically stable throughout the surgery and post-operation. There was no abnormity of the mitral valves, including mitral regurgitation.ConclusionsAlthough a very rare malformation, particularly in adults, AMVT can cause LVOT obstruction. Examination of the mitral valve using transesophageal echocardiography is important to understand the severity of LVOT obstruction.

Left ventricular outflow tract obstruction secondary to right atrial dilatation and accessory mitral valve tissue in a patient with Ebstein\u2019s anomaly- Case report

BackgroundEbsteins anomaly accounts for less than 1% of all congenital cardiac defects. Whilst typically characterised by dysfunction and anatomical defects of the right ventricle and tricuspid valve, it often co-exists with other congenital defects. Less frequently outflow tract obstruction may arise with associated haemodynamic effects and symptoms. In particular there are few reports in the literature of left ventricular outflow tract obstruction. We believe this is because symptomatic outflow tract obstruction as the presenting complaint of this condition is exceptionally rare.Case presentationWe report on a 17 year old male who was referred to the general cardiology clinic with symptoms of exertional fatigue and breathlessness. Transthoracic echocardiogram performed as part of the workup led to the diagnosis of Ebstein’s anomaly. In addition to the characteristic features of this congenital abnormality there was significant dilatation of the right atrium with resultant leftward bulging of the intraventricular septum. The anterior mitral valve leaflet was noted to be elongated with accessory chordal apparatus and demonstrated systolic anterior motion. Turbulence was noted in the left ventricular outflow tract leading to a degree of obstruction. Here we discuss the aetiology and mechanisms behind this unusual presentation.DiscussionEbstein’s anomaly arises due to chromosomal rearrangements affecting early morphogenesis of the right ventricle and tricuspid valve. Associations with other congenital defects such as interatrial communications are well documented. Less commonly the structural abnormalities of this condition lead to functional outflow tract obstruction. Whilst cases have previously described right ventricular outflow tract obstruction there are fewer reports of left ventricular outflow tract obstruction in this patient group. The structural defects that result in dilatation of the right atrium and the atrialised portion of the right ventricle can lead to leftward bulging of the interatrial septum. Turbulence can occur in the left ventricular outflow tract with resultant systolic anterior motion of the mitral valve in a mechanism similar to that encountered in hypertrophic cardiomyopathy. This may only become haemodynamically relevant during exertion.ConclusionIn the absence of ventricular dysfunction, arrhythmias or syncope we suggest that it is reasonable to adopt an observational strategy to the management of these patients.

Bands in the Heart: Multimodality Imaging Review.

Multiple bands and bandlike structures can be found within the cardiac chambers, which can be evaluated with various imaging modalities including echocardiography, CT, MRI, and invasive angiography. These bands can be classified as normal structures or normal variants, aberrant structures, or pathologic entities. Normal structures include the crista terminalis, taenia sagittalis, Chiari network, coumadin ridge, moderator band, papillary muscles, and chordae tendineae. Aberrant structures include aberrant papillary muscles, accessory chordae, false tendons, and accessory mitral valve tissue. Pathologic entities include double-chambered right ventricle, double-chambered left ventricle, cor triatriatum, and subaortic stenosis. Several types of bands are incidental findings discovered at imaging and do not produce clinical symptoms. However, some bands can mimic cardiac diseases, including masses. More importantly, some bands are pathologic entities that produce symptoms owing to hemodynamic consequences. Performing multimodality imaging helps the radiologist (a) identify, localize, and characterize the bands; (b) determine if they are normal structures, abnormal structures, or pathologic entities; (c) distinguish them from cardiac pathologic conditions; and (d) evaluate the secondary consequences of pathologic entities. This article reviews the various bands visualized within the cardiac chambers, as well as the role of imaging in depicting the bands, their appearances across various imaging modalities, and their clinical significance. Online supplemental material is available for this article. ©RSNA, 2019.

Obstructive accessory mitral valve tissue in an adult patient: a case report

BackgroundAccessory mitral valve tissue is a rare congenital anomaly that is commonly diagnosed in early childhood and rarely in adulthood. It is usually asymptomatic. However, it may cause left ventricular outflow tract obstruction in a way that mimics various other causes of obstruction.Case summaryA 72-year-old Caucasian man complained of chest discomfort and exertional dyspnea for 3 months. There were no specific findings from a physical examination except systolic murmur. Transthoracic echocardiography demonstrated a mass on the mitral valve extending to the intraventricular septal, raising the pressure gradient flow across the aortic valve. Transesophageal echocardiography showed parachute-like tissue connected to the anterior leaflet of the mitral valve causing left ventricular outflow tract obstruction. During the surgery preparation period, he underwent coronary angiography and computed tomography to study the anatomy surrounding the mass. After surgery, biopsy showed non-specific findings.ConclusionWhen facing a case of aortic valve stenosis, accessory mitral valve tissue should be kept in mind as one of the possible underlying causes despite its rarity. Although it is simple and noninvasive, echocardiography remains the best diagnostic procedure to make the correct decision about management and to define the golden time for surgical intervention.

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 ].

Left ventricular outflow obstruction secondary to accessory mitral valve tissue in a patient with hypertrophic cardiomyopathy.

Left ventricular outflow obstruction secondary to accessory mitral valve tissue in a patient with hypertrophic cardiomyopathy.

Accessory mitral valve tissue with mitral complex structural abnormality.

A 64-year-old Japanese man was referred to our hospital because of palpitation. An electrocardiogram revealed firstdegree atrioventricular block without ST-T change. An echocardiography showed structural abnormality into the left ventricular outflow tract (LVOT), mitral valve leaflet cleft without mitral regurgitation, and single papillary muscle (loss of posterior papillary muscle) (Figs. 1, 2). A structural abnormality was attached between the base of the intraventricular septum and anterior mitral leaflet, which was mobile in the cardiac cycle. Peak velocity of LVOT was 1.7 m/s. Cardiac systolic function was normal. We diagnosed accessory mitral valve tissue (AMVT) with mitral complex structural abnormality (mitral valve leaflet cleft and single papillary muscle). AMVT is a rare congenital cardiac malformation. The age of AMVT diagnosis ranged from newborns to 77 years [1]. It was reported that the incidence of AMVT in adults was 1/26,000 echocardiogram [2]. Although the exact embryologicmechanism of AMVT formation is not clear, it may stem from the abnormal or incomplete separation of the mitral valve from the endocardial cushions [3]. AMVT is associated with other congenital intracardiac and vascular malformations such as ventricular septal defect [4]. In this case, we found AMVT with a combination of mitral valve leaflet cleft and single papillary muscle (loss of posterior papillary muscle). To our knowledge, this is the first reported case of AMVT with a combination of mitral valve leaflet cleft and single papillary muscle. An echocardiography can be considered the gold standard modality for the diagnosis of AMVT with other cardiac abnormality. Although single papillary muscle usually combined the parachute mitral valve, the parachute mitral valve was not observed in this case. The majority of patients with AMVT have no symptoms, such as chest pain, palpitation, and syncope [5–7]. However, this patient was referred to our hospital because of palpitation. No arrhythmia was observed in electrocardiogram monitoring.

A rare cause of the left ventricular outflow tract obstruction: accessory mitral valve tissue (RCD code: IV-1D.2o)

Accessory mitral valve tissue is a rare congenital malformation, which often causes left ventricular outflow tract (LVOT) obstruction. Patients with accessory MVT and LVOT obstruction have poor exercise tolerance, fatigue, palpitations. The disease is mainly diagnosed in the 1st decade of life, when symptoms occur. Rarely diagnosis is made later, after 20–30 years of life, due to progressive course of the pathology with increasing gradient of LVOT obstruction. In cases of severe LVOT obstruction surgical management is recommended. We report a case of AMVT in young man diagnosed at the age of 31, when LVOT obstruction occurred and exercise intolerance developed. JRCD 2014; 1 (7): 13–16

Journal of Rare Cardiovascular Diseases: Another exciting quarter in the ‘usual’ life of the Journal

Dear Friends and Colleagues, Our Dear Readers and Supporters of the Journal, It is an extreme pleasure to deliver at your hand the 7th issue of the Journal of Rare Cardiovascular Diseases. Our two‑year anniversary has not arrived yet, so one might consider this a ‘usual’ issue. The list of the topics covered, however, shows clearly that our every‑day‘usual’ continues to be, as you will see, unusual. In contrast to the (mostly) well‑explored fields of common cardiovascular disease, in rare cardiovascular disease (RCD) patients nothing is ever ‘typical’ or ‘usual’. This issue brings, again, an exciting mixture of the advancements in rare cardiovascular disease research and reports on everyday clinical issues that the physician taking care of RCD patients is faced with. I would like to encourage you to start with reading a brief review on type 2 Long QT Syndrome, under the seemingly strange title: ‘Can an alarm clock really kill?’ (yes, it can – you will learn through what particular mechanism and how this can be prevented). The original paper in this issue provides new data on the different biochemical profile of patients presenting with heart failure of different aetiologies. This work indicates novel potential mechanisms of heart failure worsening, leading to the acute admissions in different patient groups. It will no doubt be of interest to heart failure clinicians and researchers. This issue of the Journal brings also four, very different, RCD patient reports. Dr Nelya Oryshchyn and colleagues from the Lviv Medical University discuss in detail a rare cause of the left ventricular outflow tract obstruction caused by accessory mitral valve tissue. Dr Dziedzic‑Oleksy and colleagues share with us the diagnostic and decision‑making pathway in an unusual patient with aortic stenosis. Dr Karch and colleagues, on the basis of a young asymptomatic professional football player referred to their attention, discuss management of athletes with isolated left ventricular noncompaction. Finally, Dr Drabik and colleagues present views on how to manage a young female patient with significant left‑to‑right shunt at the ventricular septal level and severe pulmonary regurgitation in a young woman many years after tetralogy of Fallot surgical correction. The final item in this issue is a report from the annual Conference of the Polish Society of Cardiology Working Group on Congenital Heart Diseases, with a strong presence of the Krakow RCD Centre. Let me close this note from Editor by thanking you again for your work with us, not only as Readers but also as contributors to the Journal. Please feel free to agree and (equally) disagree with what you read in the Journal (NB. we shall soon include a ‘Letters to Editor’ column). Hardly anything can be more constructive that an exchange of informed views and experiences. Feel free to submit an Original Paper, Review, or a Case Report. I am pleased to inform you that the Journal is on the right path towards receiving recognition with an impact factor. Piotr Podolec Editor‑in‑Chief Journal of Rare Cardiovascular Diseases