Successful mitral valve repair for severe mitral regurgitation caused by isolated cleft of the posterior leaflet

doi:10.1016/j.ijcard.2009.09.525

International Journal of Cardiology

Volume 150, Issue 2, 15 July 2011, Pages e48-e49

https://doi.org/10.1016/j.ijcard.2009.09.525 Get rights and content

Abstract

Cleft of the post mitral valve leaflet is extremely rare congenital cause of mitral regurgitation. Only six cases have being reported in literature. We report the case of a 34-year-old man with isolated cleft in the posterior mitral valve leaflet causing severe mitral regurgitation. The patient had been experiencing limitation of his exercise capacity becoming more easily tried. Therefore, he was referred for mitral valve surgery. The posterior mitral valve leaflet was successfully repaired using quadrangular resection technique. Intra-operative transesophageal echocardiography showed trivial mitral regurgitation after repair. Satisfactory clinical results were achieved at 2 years post-operatively.

Section snippets

Case report

A 34-year-old man with severe mitral regurgitation was referred to our institution for mitral valve surgery. He had been experiencing limitation of his exercise capacity becoming more easily tried. Medical history was notable for chronic hepatitis B infection. He was of athletic build. There were no signs of chronic liver disease. His pulse was regular, 72 beats per minute. The jugular venous pressure was within the normal range. Auscultation revealed a grade 5/6 pan systolic murmur maximum at

Discussion

Cleft of the posterior mitral valve leaflet is an extremely rare congenital cardiovascular malformation. Only six cases have being reported in literature [1], [2], [3], [4], [5], [6]. Isolated cleft posterior mitral valve leaflet were observed in 3 cases [1], [2], [3]. Associated anomalies include counterclockwise papillary muscles[4] or an accessory mitral valve tissue[5]. Cleft is a slit-like defect which can be clearly imaged by the two-dimensional echocardiography. Mechanism for the

Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [7].

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There are more references available in the full text version of this article.

Cited by (4)

The Trileaflet Mitral Valve
2018, American Journal of Cardiology
Citation Excerpt :
Isolated clefting of the mural leaflet of the otherwise normal mitral valve is an extremely rare but long-reported congenital heart condition.20,27 Only few cases are reported in the literature.7–22 The cleft is usually oriented away from the LVOT, which is similar to the situation in the patients with AVSD, where the so-called cleft is the zone of apposition located between the superior and the inferior bridging leaflets.28
With the advent of 3-dimensional echocardiography, visualization of the mitral valve has greatly improved. Recently, there has been an increase in reporting of a distinct entity called the “trileaflet mitral valve” using 3-dimensional echocardiography. It is controversial whether this is a new entity or an improved visualization of isolated mitral valve clefts or trifoliate left atrioventricular valve in the setting of an atrioventricular septal defect (AVSD) with intact septum. We present a case of a trifoliate valve, interpreting our findings based on a systematic review of previous publication on trileaflet mitral valves, isolated clefts in the mural (posterior) leaflet of the mitral valve, and trifoliate left atrioventricular valves with AVSD and intact septal structures. We describe the latter entity as a left atrioventricular valve because it never achieves the features of a normal mitral valve. We compare the features of isolated clefts of the mural leaflet of the mitral valve with trifoliate left atrioventricular valve found in the setting of AVSDs with intact septal structures to illustrate the current controversy regarding these conditions. In conclusion, our review suggested the reported trileaflet left atrioventricular valves is likely a misnomer because of a lack of consideration of embryologic development and nomenclature, rather than a greater appreciation and identification of a new distinct disease entity.
Robotic mitral valve plasty for isolated clefts of mitral valve leaflets
2022, Asian Journal of Endoscopic Surgery
Isolated Congenital Cleft Mitral Valve Leaflet: A Rare Cause of Refractory Cardiogenic Shock Complicating Acute Myocardial Infarction
2020, Research Square
Diagnosis of mitral valve cleft using real-time 3-dimensional echocardiography
2017, Journal of Thoracic Disease

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Letter to the EditorSuccessful mitral valve repair for severe mitral regurgitation caused by isolated cleft of the posterior leaflet

Abstract

Section snippets

Case report

Discussion

Acknowledgement

Int J Cardiol

J Am Soc Echocardiogr

Ann Thorac Surg

Letter to the Editor
Successful mitral valve repair for severe mitral regurgitation caused by isolated cleft of the posterior leaflet