Prevalence of asymptomatic mitral valve malformations

Incidental Findings of Congenital Unileaflet Mitral Valves in Young Patient Presenting Complete Atrioventricular Block

The singular leaflet mitral valve is a rare and complex entity that has been described in only a few case reports. It is commonly observed in infancy and combined with symptomatic mitral regurgitation (MR). In most asymptomatic individuals, this complication is attributed mainly to a hypoplastic posterior mitral leaflet and is usually revealed in adulthood. We present the case of a 30-year-old man who presented with chest pain and dyspnea for two days. The electrocardiogram showed complete atrioventricular block with a beat rate of 30 bpm. Echocardiography revealed an elongated anterior mitral valve leaflet and an almost completely absent posterior mitral valve leaflet with no MR. Our case is unusual presentation of a unileaflet mitral valve that should be investigated even in adulthood as these patients are likely to be at risk of developing or worsening MR later in life; hence, performing periodic echocardiograms is important for detecting the progression of MR early.

Description and prevalence of ventricular mitral annular disjunction: variation of normality or pathological variant?

INTRODUCTION AND OBJECTIVES

The aim of this study was to investigate a new variation of the atrial wall-mitral annulus-ventricular wall junction along the mural mitral leaflet and commissures: the ventricular mitral annular disjunction (v-MAD). This new variant is characterized by spatial displacement of the mitral leaflet hinge line by more than 2mm toward the left ventricle.

METHODS

We examined a cohort of autopsied human hearts (n=224, 21.9% females, 47.9±17.6 years) from patients without known cardiovascular disease to identify the presence of v-MAD.

RESULTS

More than half (57.1%) of the hearts showed no signs of MAD in the mural mitral leaflet or mitral commissures. However, v-MAD was found in 23.6% of cases, located within 20.1% of mural leaflets, 2.2% in superolateral commissures, and 1.3% in inferoseptal commissures. V-MAD was not uniformly distributed along the mitral annulus circumference, with the most frequent site being the P2 scallop (19.6% of hearts). The v-MAD height was significantly greater in mural leaflets than in commissures (4.4 mm±1.2 mm vs 2.1 mm±0.1 mm; P<.001). No specific variations in mitral valve morphology or anthropometrical features of donors were associated with the presence or distribution of v-MADs. Microscopic examinations revealed the overlap of the thin layer of atrial myocardium over ventricular myocardium in areas of v-MAD.

CONCLUSIONS

Our study is the first to present a detailed definition and morphometric description of v-MAD. Further studies should focus on the clinical significance of v-MAD to elucidate whether it represents a benign anatomical variant or a significant clinical anomaly.

Hypoplastic Posterior Leaflet Mitral Valve Associated with Bicuspid Aortic Valve

•Hypoplasia of the MV posterior leaflet is a rare congenital anomaly. •Differential diagnosis includes other anomalies of the mitral apparatus. •TTE and TEE are cornerstones for proper preoperative planning. •HPMVL tends to be incompatible with life. •Association of HPMVL with a BAV is extraordinarily rare.

Challenge in mitral valve intervention: Super-elongated anterior and diminutive posterior mitral valve

Diminutive posterior mitral valve leaflet with an extremely elongated anterior leaflet is a rare phenomenon. We share such a case discovered in an 82-year-old patient with severe, symptomatic mitral regurgitation. LA, left atrium; LV, left ventricle; MR, mitral regurgitation.

Unileaflet Mitral Valve in Patient With Marfanoid Habitus

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Unileaflet mitral valve is a very rare congenital heart condition.

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It is usually lethal in neonates with severe regurgitation.

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Rare asymptomatic cases can be diagnosed later in life.

Mitral Ebstein's Anomaly Modified with a Scarred Rhabdomyoma in Tuberous Sclerosis: An Extremely Rare Cause of Mitral Insufficiency

We present an extremely rare case of mitral Ebstein's anomaly that resulted in severe mitral regurgitation (MR). A 41-year-old woman with a history of tuberous sclerosis underwent surgery. Preoperatively, it was assumed that MR had occurred due to leaflet tethering related to left ventricular posterior wall motion asynergy due to a scarred rhabdomyoma. However, surgical inspection revealed a dysplastic posterior leaflet adhering to the ventricular wall, which was completely covered by the endocardium. Both congenital mitral Ebstein's anomaly and acquired wall motion abnormality due to a scarred rhabdomyoma may have contributed to the development of severe MR in this case.

Surgical Repair of a Unileaflet Mitral Valve: A Rare Congenital Abnormality and a Novel Surgical Approach

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The authors report a novel approach for MV repair.

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ULMV is rare in clinical practice.

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Comprehensive multimodality cardiac imaging can delineate complex valvular pathology.

Fetal and Postnatal Echocardiographic Diagnosis of Ebstein Anomaly of the Mitral Valve

Ebstein anomaly of mitral valve (MV) is an extremely rare congenital heart disease. In the current report, we present a case of Ebstein of MV that was diagnosed prenatally. Fetal echocardiogram showed that the posterior leaflet of MV was tethered to the lateral wall of left ventricle (LV) with downward displacement into LV cavity. Postnatal transthoracic and transesophageal echocardiograms confirmed the diagnosis with apical displacement of the level of coaptation MV into the LV cavity. To the best of our knowledge, fetal diagnosis of Ebstein anomaly of MV has not yet been reported in the medical literature.

Hypoplastic posterior mitral valve leaflet: A case report and review of the literature

Hypoplasia of the mitral leaflets is rarely reported in adults. We reported a 45-year-old man presented to us with palpitation, dyspnea, and severe mitral regurgitation. In echocardiographic examination, an immobile hypoplastic posterior mitral leaflet (PML) was detected. A review of clinical and echocardiographic findings of all reported cases revealed that mitral regurgitation was the most common finding associated with PML hypoplasia/uni-leaflet mitral valve. PML hypoplasia is rare and often an incidental diagnosis during echocardiography, which could be relatively well tolerated since adulthood and carries a good prognosis.

Hypoplasia of the posterior mitral leaflet: A rare cause of mitral regurgitation in adulthood

Hypoplasia of the posterior mitral valve leaflet (PMVL) is a rare congenital heart disease, usually presenting in infancy and childhood with severe mitral regurgitation, either in isolation or associated with other cardiac lesions. We report a case of a 69-year-old woman with recent-onset exertional dyspnea and severe mitral regurgitation. Two- and three-dimensional transesophageal echocardiography showed severe hypoplasia of the PMVL, confirmed by surgical inspection.

Rare Case of Unileaflet Mitral Valve

Unileaflet mitral valve is the rarest of the congenital mitral valve anomalies and is usually life threatening in infancy due to severe mitral regurgitation (MR). In most asymptomatic individuals, it is mostly due to hypoplastic posterior mitral leaflet. We present a 22-year-old male with palpitations, who was found to have an echocardiogram revealing an elongated anterior mitral valve leaflet with severely hypoplastic posterior mitral valve leaflet appearing as a unileaflet mitral valve without MR. Our case is one of the 11 reported cases in the literature so far. We hereby review those cases and conclude that these patients are likely to be at risk of developing worsening MR later in their lives.

Severe Mitral Regurgitation Secondary to Atresia of the Posterior Mitral Valve Leaflet in the Adult: Is Repair Always Best Practice?

We describe a case of a 66-year-old woman with severe mitral regurgitation secondary to posterior leaflet atresia of the mitral valve. Perioperative transesophageal echocardiography suggested the possibility of an absent posterior leaflet with complete prolapse of the anterior leaflet. We questioned the functional outcome if repair was attempted; therefore, mitral valve replacement was performed. We present a case outlining the successful management of this rare condition in an adult as well as a review of current literature.

Unique congenital malformation of the mitral valve associated with anomalous coronary arteries and stroke

A 55-year-old male presented with stroke. Transesophageal echocardiogram and cardiac computed tomography revealed an unrecognized congenital malformation of the anterior mitral leaflet associated with anomalous left coronary circumflex artery, arising from the right coronary artery, diagnosed first by echocardiogram. This case represents a unique unforeseen mitral valve anomaly that might be considered as potential cardiac source of embolism. This finding broadens the spectrum of known mitral valve anomalies.

Isolated Ebstein's anomaly of mitral valve in an adult patient with systemic lupus erythematosus

We present a rare case of isolated Ebstein's mitral valve anomaly, associated with systemic lupus erythematosus in an adult patient. We establish a correlation between the echocardiographic image of the patient and an anatomically equivalent heart.

Functionally uni-leaflet mitral valves in a family: a case series

Functionally uni-leaflet mitral valves are extremely rare. In severe cases, they are considered incompatible with life beyond the neonatal period. We present a case series of three adults with almost complete absence of the posterior mitral valve leaflet and who are asymptomatic, with no more than mild mitral regurgitation. We believe that this is the first reported instance of such findings in a single family.