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Isolated Anterior Mitral Valve Leaflet Cleft: 3D Transthoracic Echocardiography-Guided Surgical Strategy.

Miglioranza MH, Muraru D, Mihaila S, Haertel JC, Iliceto S, Badano LP - Arq. Bras. Cardiol. (2015)

View Article: PubMed Central - PubMed

Affiliation: Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.

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Isolated cleft of the anterior mitral leaflet (not associated with atrioventricular septal defect) is a rare cause of congenital mitral regurgitation... the defect was 0.8-cm large and 1.2-cm deep with a planimetric anatomic regurgitant area of 0.7 cm, while the effective regurgitant orifice was 0.61 cm... isolated cleft of the anterior mitral leaflet (ICAML)... defect, the severity of the regurgitation, and its location near the posteromedial commissural, neither a direct suture nor an autologous pericardium patch implant was No other abnormalities of the mitral apparatus were found... A 31-mm St. Jude Medical Biocor® prosthesis was then successfully implanted according to the patient’s choice... mitral valve leaflet that is not associated with an ostium primum atrial septal defect of the mitral valve because real-time anatomical views of the mitral valve similar to to the actual surgery... This strategy will reduce patient discomfort and the

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A) 2D apical two-chamber view showing a defect in the anterior leaflet, where aneccentric regurgitant flow path is identified by color Doppler; B) 2D short-axisview just below the aortic root, at the level of the aortic to mitral valvefibrous continuity; C) continuous Doppler tracing of the regurgitant flow, showinga dense spectrum suggestive of severe regurgitation; D and E) 3D ventricular andatrial, respectively, "en face" views of the mitral valve at mid-systole showingthe anatomic orifice with 3D planimetric area and diameter measurements; F) 3Datrial "en face" view of the mitral valve at diastole demonstrating the cleft inA3; G) 3D TTE acquisition demonstrating the defect in the anterior leaflet echolocalized in A3 (note the division in the anterior leaflet as indicated by thearrow); H) 3D ventricular "en face" view of the mitral valve with color Doppler,demonstrating the PISA at the A3 portion; I) 3D effective regurgitant orificeplanimetric area.
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f02: A) 2D apical two-chamber view showing a defect in the anterior leaflet, where aneccentric regurgitant flow path is identified by color Doppler; B) 2D short-axisview just below the aortic root, at the level of the aortic to mitral valvefibrous continuity; C) continuous Doppler tracing of the regurgitant flow, showinga dense spectrum suggestive of severe regurgitation; D and E) 3D ventricular andatrial, respectively, "en face" views of the mitral valve at mid-systole showingthe anatomic orifice with 3D planimetric area and diameter measurements; F) 3Datrial "en face" view of the mitral valve at diastole demonstrating the cleft inA3; G) 3D TTE acquisition demonstrating the defect in the anterior leaflet echolocalized in A3 (note the division in the anterior leaflet as indicated by thearrow); H) 3D ventricular "en face" view of the mitral valve with color Doppler,demonstrating the PISA at the A3 portion; I) 3D effective regurgitant orificeplanimetric area.

Mentions: An 18-year-old asymptomatic man with a history of systolic murmur from childhoodpresented for a cardiac evaluation. Cardiac examination detected an apical holosystolicmurmur radiating to the axilla. His 12-lead rest electrocardiogram was normal. Atwo-dimensional (2D) TTE showed the presence of a severe eccentric mitral regurgitationjet directed towards the lateral wall of the enlarged let atrium (Figures A and B and Video 1). The mitral annulus was normally sized. Theleft ventricle showed normal size and function. No other cardiac abnormalities weredetected by 2D TTE. To better define the anatomy of the mitral valve, 3D TTE wasperformed. "En face" views of the mitral valve were obtained by cropping 3D data setsacquired from both the apical and the parasternal acoustic windows. A defect wasvisualized in the anterior leaflet of the mitral valve at the level of the A3 scallop(Figures D-Figures D and Video 2). At mid-systole,the defect was 0.8-cm large and 1.2-cm deep with a planimetric anatomic regurgitant areaof 0.7 cm2, while the effective regurgitant orifice was 0.61 cm2.Potential acquired causes of this morphological finding such as previous trauma,surgery, and infective endocarditis were also excluded, and the final diagnosis wasisolated cleft of the anterior mitral leaflet (ICAML). Considering the large size of thedefect, the severity of the regurgitation, and its location near the posteromedialcommissural, neither a direct suture nor an autologous pericardium patch implant wasconsidered feasible surgical options (Videos 3 and4).


Isolated Anterior Mitral Valve Leaflet Cleft: 3D Transthoracic Echocardiography-Guided Surgical Strategy.

Miglioranza MH, Muraru D, Mihaila S, Haertel JC, Iliceto S, Badano LP - Arq. Bras. Cardiol. (2015)

A) 2D apical two-chamber view showing a defect in the anterior leaflet, where aneccentric regurgitant flow path is identified by color Doppler; B) 2D short-axisview just below the aortic root, at the level of the aortic to mitral valvefibrous continuity; C) continuous Doppler tracing of the regurgitant flow, showinga dense spectrum suggestive of severe regurgitation; D and E) 3D ventricular andatrial, respectively, "en face" views of the mitral valve at mid-systole showingthe anatomic orifice with 3D planimetric area and diameter measurements; F) 3Datrial "en face" view of the mitral valve at diastole demonstrating the cleft inA3; G) 3D TTE acquisition demonstrating the defect in the anterior leaflet echolocalized in A3 (note the division in the anterior leaflet as indicated by thearrow); H) 3D ventricular "en face" view of the mitral valve with color Doppler,demonstrating the PISA at the A3 portion; I) 3D effective regurgitant orificeplanimetric area.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495461&req=5

f02: A) 2D apical two-chamber view showing a defect in the anterior leaflet, where aneccentric regurgitant flow path is identified by color Doppler; B) 2D short-axisview just below the aortic root, at the level of the aortic to mitral valvefibrous continuity; C) continuous Doppler tracing of the regurgitant flow, showinga dense spectrum suggestive of severe regurgitation; D and E) 3D ventricular andatrial, respectively, "en face" views of the mitral valve at mid-systole showingthe anatomic orifice with 3D planimetric area and diameter measurements; F) 3Datrial "en face" view of the mitral valve at diastole demonstrating the cleft inA3; G) 3D TTE acquisition demonstrating the defect in the anterior leaflet echolocalized in A3 (note the division in the anterior leaflet as indicated by thearrow); H) 3D ventricular "en face" view of the mitral valve with color Doppler,demonstrating the PISA at the A3 portion; I) 3D effective regurgitant orificeplanimetric area.
Mentions: An 18-year-old asymptomatic man with a history of systolic murmur from childhoodpresented for a cardiac evaluation. Cardiac examination detected an apical holosystolicmurmur radiating to the axilla. His 12-lead rest electrocardiogram was normal. Atwo-dimensional (2D) TTE showed the presence of a severe eccentric mitral regurgitationjet directed towards the lateral wall of the enlarged let atrium (Figures A and B and Video 1). The mitral annulus was normally sized. Theleft ventricle showed normal size and function. No other cardiac abnormalities weredetected by 2D TTE. To better define the anatomy of the mitral valve, 3D TTE wasperformed. "En face" views of the mitral valve were obtained by cropping 3D data setsacquired from both the apical and the parasternal acoustic windows. A defect wasvisualized in the anterior leaflet of the mitral valve at the level of the A3 scallop(Figures D-Figures D and Video 2). At mid-systole,the defect was 0.8-cm large and 1.2-cm deep with a planimetric anatomic regurgitant areaof 0.7 cm2, while the effective regurgitant orifice was 0.61 cm2.Potential acquired causes of this morphological finding such as previous trauma,surgery, and infective endocarditis were also excluded, and the final diagnosis wasisolated cleft of the anterior mitral leaflet (ICAML). Considering the large size of thedefect, the severity of the regurgitation, and its location near the posteromedialcommissural, neither a direct suture nor an autologous pericardium patch implant wasconsidered feasible surgical options (Videos 3 and4).

View Article: PubMed Central - PubMed

Affiliation: Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Isolated cleft of the anterior mitral leaflet (not associated with atrioventricular septal defect) is a rare cause of congenital mitral regurgitation... the defect was 0.8-cm large and 1.2-cm deep with a planimetric anatomic regurgitant area of 0.7 cm, while the effective regurgitant orifice was 0.61 cm... isolated cleft of the anterior mitral leaflet (ICAML)... defect, the severity of the regurgitation, and its location near the posteromedial commissural, neither a direct suture nor an autologous pericardium patch implant was No other abnormalities of the mitral apparatus were found... A 31-mm St. Jude Medical Biocor® prosthesis was then successfully implanted according to the patient’s choice... mitral valve leaflet that is not associated with an ostium primum atrial septal defect of the mitral valve because real-time anatomical views of the mitral valve similar to to the actual surgery... This strategy will reduce patient discomfort and the

Show MeSH
Related in: MedlinePlus