1
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Eto H, Uzu K, Nagasawa Y, Shimokawa Y, Okubo H, Shimizu H. A case of percutaneous septal myocardial ablation in a patient with obstructive hypertrophic cardiomyopathy with accessory mitral valve tissue. J Cardiol Cases 2024; 29:39-42. [PMID: 38188315 PMCID: PMC10770088 DOI: 10.1016/j.jccase.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 01/09/2024] Open
Abstract
Accessory mitral valve tissue (AMVT) is a rare congenital anomaly that sometimes causes left ventricular outflow tract (LVOT) obstruction. We report the case of a 72-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) complicated by AMVT. The patient presented at our hospital with palpitations and shortness of breath. Transthoracic echocardiography revealed a diagnosis of HOCM and an abnormal structure inside the LVOT. Transesophageal echocardiography revealed an AMVT. We initially treated the patient with oral medication, but due to side effects, the patient could not take the target dose and her symptoms did not improve. We suggested surgical treatment, but the patient refused. By evaluating the relationship between AMVT and the surrounding tissues using three-dimensional transesophageal echocardiography, we determined that percutaneous septal myocardial ablation (PTSMA) might be successful. The first PTSMA was not effective, but the second procedure showed significant improvement in the pressure gradient and symptoms. The patient with HOCM and concomitant AMVT had a severe LVOT pressure gradient, and PTSMA was performed with excellent results. Since we experienced a rare case and were able to treat it percutaneously, we report our findings in relation to the literature. Learning objective This case study highlights successful use of percutaneous septal myocardial ablation (PTSMA) in treating a patient with hypertrophic obstructive cardiomyopathy (HOCM) and accessory mitral valve tissue (AMVT). The key objective is to understand PTSMA can be an effective treatment option for HOCM with Type IIa AMVT, characterized by the attachment only to the mitral leaflets, when surgical intervention is not preferred, enhancing management of this rare condition.
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Affiliation(s)
- Hiroaki Eto
- Department of Cardiology, Konan Medical Center, Kobe, Japan
| | - Kenzo Uzu
- Department of Cardiology, Konan Medical Center, Kobe, Japan
| | | | | | - Hideaki Okubo
- Department of Cardiology, Konan Medical Center, Kobe, Japan
| | - Hiroki Shimizu
- Department of Cardiology, Konan Medical Center, Kobe, Japan
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2
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Hammami R, Kammoun A, Hassine M, Ellouze T, Gargouri R, Abid L. Hypertrophic obstructive cardiomyopathy with left ventricle outflow tract chordae insertion: Surgery or alcohol septal ablation? A case report. Clin Case Rep 2023; 11:e7928. [PMID: 37744623 PMCID: PMC10514372 DOI: 10.1002/ccr3.7928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Anomalous insertion of chordae is a rare disease that could be associated with hypertrophic obstructive cardiomyopathy (HOCM), but clinical and echocardiographic diagnoses tend to be delayed. Alcohol septal ablation has emerged as an alternative to surgical myomectomy in HOCM. When a patient showed an anomalous insertion of chordae, physicians generally opt for surgery and not alcohol septal ablation. In this report, we present the case of a lady, with symptomatic HOCM associated with a chord inserted on the left ventricular outflow tract. We succeeded to relieve obstruction by alcohol septal ablation without the need for surgery.
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Affiliation(s)
- Rania Hammami
- Cardiology Department, Faculty of MedicineUniversity of SfaxSfaxTunisia
| | - Amine Kammoun
- Cardiology Department, Faculty of MedicineUniversity of SfaxSfaxTunisia
| | - Majed Hassine
- Cardiology A Department Fattouma Bourguiba University Hospital, Cardiothrombosis Research Laboratory (LR12SP16)University of MonastirMonastirTunisia
| | - Tarek Ellouze
- Cardiology Department, Faculty of MedicineUniversity of SfaxSfaxTunisia
| | - Rania Gargouri
- Cardiology Department, Faculty of MedicineUniversity of SfaxSfaxTunisia
| | - Leila Abid
- Cardiology Department, Faculty of MedicineUniversity of SfaxSfaxTunisia
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3
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Azak E, Aydın NH, Ecevit NA, Cetin II, Golbasi Z. Incidental detection of accessory mitral valve in adolescent with atrial septal defect: Diagnosis with 3D transesophageal echocardiography and excision with transaortic method. Echocardiography 2022; 39:851-854. [PMID: 35610733 DOI: 10.1111/echo.15369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/20/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Accessory mitral valve tissue (AMVT) is an extremely rare causes left ventricular outflow tract (LVOT) obstruction and is usually incidentally detected in childhood. It is often associated with other cardiac and vascular congenital malformations. CASE PRESENTATION In this case, we present a 15-year-old girl was diagnosed with AMVT by transesophageal echocardiography, resulting in LVOT obstruction during systole. Interestingly enough, the patient's accessory mitral valve remained undetected for years until he became symptomatic for wide ASD. Successful closure of the ASD with resection of the AMVT was performed with a transaortic approach. The patient was hemodynamically stable postoperatively. There were no abnormalities in the mitral valves and LVOT. CONCLUSION It was also unusual to see AMVT with ASD instead of other frequently associated other congenital anomalies. Accessory mitral valve should be considered a rare but important cause of left ventricular outflow tract obstruction in childhood.
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Affiliation(s)
- Emine Azak
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Nuri Hakan Aydın
- Department of Pediatric Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Niyazi Ata Ecevit
- Department of Pediatric Cardiovascular Surgery, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Ibrahim Ilker Cetin
- Department of Pediatric Cardiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Zehra Golbasi
- Department of Cardiology, Faculty of Medicine, Ankara City Hospital, Yıldırım Beyazıt University, Ankara, Turkey
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4
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Craft JA, Reidy MR, Craft JA, Pieper SJ, Donnelly JE. Accessory Mitral Valve Tissue and Internal Mammary Artery Stenosis. JACC Case Rep 2022; 4:167-169. [PMID: 35199010 PMCID: PMC8853953 DOI: 10.1016/j.jaccas.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/12/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
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.)
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Affiliation(s)
- Joseph A. Craft
- Department of Cardiology, St. Luke’s Hospital, St. Louis, Missouri, USA
- Address for correspondence: Dr. Joseph A. Craft III, St. Luke’s Hospital, Department of Cardiology, 450 N. New Ballas Road, Suite 270 West, St. Louis, Missouri 63141, USA. @CraftJosephMD
| | - Michael R. Reidy
- Department of Cardiothoracic Surgery, St. Luke’s Hospital, St. Louis, Missouri, USA
| | | | - Stephen J. Pieper
- Department of Electrophysiology, St. Luke’s Hospital, St. Louis, Missouri, USA
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5
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Theodoropoulos KC, Avci Demir F, Masoero G, Lukban BF, Fonseca T, Monaghan MJ, Papachristidis A. Incidental finding of accessory mitral valve tissue on routine adult echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:805-807. [PMID: 33644857 DOI: 10.1002/jcu.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Accessory mitral valve tissue is a rare congenital cardiac abnormality that sometimes can cause left ventricular outflow tract obstruction. We herein present the case of a 55-year-old male with an incidental finding of accessory mitral valve tissue on transthoracic echocardiography. The patient was managed conservatively as accessory tissue was not causing left ventricular outflow obstruction and there were no hemodynamic consequences.
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Affiliation(s)
| | - Fulya Avci Demir
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Giovani Masoero
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Benito Francisco Lukban
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Tiago Fonseca
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Mark J Monaghan
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
| | - Alexandros Papachristidis
- Department of Echocardiography, King's College Hospital NHS Foundation Trust, King's College London, London, UK
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6
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Kim S, Lee SK, Choi J. Echocardiographic features of accessory mitral valve tissue presenting left ventricular outflow tract obstruction in a dog. J Vet Sci 2021; 22:e57. [PMID: 34313042 PMCID: PMC8318797 DOI: 10.4142/jvs.2021.22.e57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/15/2021] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
In a 3-year-old Samoyed, aortic bulging was found on radiography during a general check-up. On echocardiography, turbulent flow was found in left ventricular outflow tract (LVOT) with high velocity (6.1 m/s). A linear structure was attached to the interventricular septum and connected to the chordae tendineae reaching the papillary muscle. A part of the structure moved during cardiac cycle, similar to mitral motion. This dog was diagnosed with LVOT obstruction caused by accessory mitral valve tissue (AMVT). This is the first report of AMVT in veterinary medicine. AMVT should be considered as a possible cause of LVOT obstruction in dogs.
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Affiliation(s)
- Soyeon Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Sang Kwon Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea.
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7
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Yetkin E, Cuglan B, Turhan H, Yalta K. Accessory mitral valve tissue: anatomical and clinical perspectives. Cardiovasc Pathol 2020; 50:107277. [PMID: 32882373 DOI: 10.1016/j.carpath.2020.107277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/14/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
Mitral valve is a complex cardiac structure composed of several components to work in synchrony to allow blood flow into left ventricle during diastole and not to allow blood flow into left atrium during systole. Accessory mitral valve tissue (AMVT) was defined as existence of any additional part and parcel of valvular structure which has an attachment to normal mitral valve apparatus in left-sided cardiac chambers. AMVT may present itself in different clinical circumstances ranging from a silent clinical course to thromboembolic events, heart failure, left ventricular outflow tract obstruction, and severe arrhythmia. This article reviews the clinical perspectives of AMVT in terms of symptoms, diagnosis, and treatment, providing a new anatomical classification regarding the location of AMVT. Briefly type I refers to AMVT having attachments on the supra leaflets level, type II refers to attachments on the mitral leaflets, and type III refers to attachment below the mitral leaflets. Increased awareness and widespread use of echocardiographic techniques would increase recognition of AMVT in patients with heart murmurs but otherwise healthy and in those with left ventricular outflow tract obstruction or tissue which causes subaortic stenosis and with unexplained cerebrovascular events.
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Affiliation(s)
- Ertan Yetkin
- Istinye University, Faculty of Medicine Department of Cardiology, Istanbul Turkey.
| | - Bilal Cuglan
- Beykent University, Faculty of Medicine Department of Cardiology, Istanbul Turkey
| | - Hasan Turhan
- Istinye University, Faculty of Medicine Department of Cardiology, Istanbul Turkey
| | - Kenan Yalta
- Trakya University, Faculty of Medicine Department of Cardiology, Edirne Turkey
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8
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Akanya DT, Lau FD, Haq FU, Hillman J, Stawiarski K, Zarich S, Pollack A. Parachute Mitral Valve: A Case of Isolated Accessory Mitral Valve Tissue. JACC Case Rep 2020; 2:1578-1581. [PMID: 34317022 PMCID: PMC8302158 DOI: 10.1016/j.jaccas.2020.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 06/13/2023]
Abstract
A 69-year-old male presented to the emergency room with dyspnea on exertion lasting more than 2 weeks. Echocardiography showed an ill-defined subaortic structure. Subsequent transesophageal echocardiography revealed a parachute-like structure prolapsing into the left ventricular outflow tract causing subvalvular aortic obstruction. Surgical excision confirmed this structure as an accessory anterior mitral leaflet. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Deborah Tosin Akanya
- Department of Cardiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Freddy Duarte Lau
- Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Faheem Ul Haq
- Department of Cardiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Joshua Hillman
- Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Kristin Stawiarski
- Department of Cardiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Stuart Zarich
- Department of Cardiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
| | - Ari Pollack
- Department of Cardiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut
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9
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Tennichi T, Taniguchi T. Accessory mitral valve tissue that caused a left ventricular outflow tract obstruction: a case report. JA Clin Rep 2019; 5:86. [PMID: 32026030 PMCID: PMC6967299 DOI: 10.1186/s40981-019-0306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Accessory 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 PRESENTATION A 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. CONCLUSIONS Although 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.
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Affiliation(s)
- Takashi Tennichi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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10
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Gurrieri C, Nelson J, Wurm H, Cicek MS, Maalouf JF. An Extremely Rare Cause of Mitral Regurgitation-Accessory Commissural Mitral Tissue with Anomalous Left Atrial Chordal Attachment. ACTA ACUST UNITED AC 2019; 3:200-203. [PMID: 31709370 PMCID: PMC6833125 DOI: 10.1016/j.case.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accessory mitral tissue and left atrial chordae are rare congenital abnormalities. Accessory mitral tissue can result in left ventricular outflow tract and mitral valve obstruction. This is the first case of lateral mitral accessory tissue with an associate anomalous chord. Transthoracic echocardiography may not be able to evaluate accessory mitral valve tissue. Removal of anomalous chordae affecting the mitral valve may be complicated.
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Affiliation(s)
| | - James Nelson
- Department of Anesthesiology, Cardiovascular Division, Mayo Clinic, Rochester, Minnesota
| | - Heather Wurm
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | - M Sertac Cicek
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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11
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Rajiah P, MacNamara J, Chaturvedi A, Ashwath R, Fulton NL, Goerne H. Bands in the Heart: Multimodality Imaging Review. Radiographics 2019; 39:1238-1263. [DOI: 10.1148/rg.2019180176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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12
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Mardenli M, Samman A, Alkanj H, Babi A. Obstructive accessory mitral valve tissue in an adult patient: a case report. J Med Case Rep 2019; 13:184. [PMID: 31203815 PMCID: PMC6572748 DOI: 10.1186/s13256-019-2110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 05/01/2019] [Indexed: 11/11/2022] Open
Abstract
Background Accessory 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 summary A 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. Conclusion When 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. Electronic supplementary material The online version of this article (10.1186/s13256-019-2110-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahmoud Mardenli
- Cardiology Department, Aleppo University Hospital, Aleppo, Syria
| | - Abdulla Samman
- Cardiology Department, Aleppo University Hospital, Aleppo, Syria.
| | - Hussein Alkanj
- Cardiac Surgery Department, Aleppo University Hospital, Aleppo, Syria
| | - Amal Babi
- Echocardiography Department, Aleppo University Hospital, Aleppo, Syria
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13
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Li Y, Hu Y, Wang J, Liu L. A rare case of accessory mitral valve tissue causing left ventricular outflow tract obstruction associated with parachute mitral valve, ventricular septal defect, bicuspid aortic valve, unruptured aneurysm of aortic sinus: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 2:yty082. [PMID: 31020159 PMCID: PMC6177097 DOI: 10.1093/ehjcr/yty082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/23/2018] [Indexed: 11/12/2022]
Abstract
Background Accessory mitral valve tissue rarely causes left ventricular outflow tract obstruction in adults. It is often associated with other cardiac and vascular congenital malformations. Here, we report the rarest presentation of accessory mitral valve tissue (AMVT) causing left ventricular outflow tract obstruction. Case summary A 22-year-old female patient presented with a history of shortness of breath and chest pain for more than 5 years. A diagnosis of AMVT with parachute mitral valve, ventricular septal defect (VSD), bicuspid aortic valve, unruptured aneurysm of aortic sinus, and left ventricular outflow tract obstruction was made. Successful closure of VSD with mitral valve replacement, excision of AMVT, and repair of the aortic sinus were performed. The post-operative course was uneventful, and an echocardiogram showed complete resection of the accessory mitral valve, no residual shunt and no left ventricular outflow gradient. Additionally, the peak gradient of rapid filling phase and atrial systolic phase across the prosthetic mitral valve were 16 mmHg and 4 mmHg, respectively. The peak velocity across left ventricular outflow tract was 1.4 m/s. Discussion Accessory mitral valve tissue is associated with other cardiac abnormalities and is usually diagnosed in the first or second decade of life. It is responsible for left ventricular outflow tract obstruction. The obstruction can occur in the early period of life due to continued deposition of fibrous tissues within left ventricular outflow tract. Accessory mitral valve tissue should be considered a rare but important cause of left ventricular outflow tract obstruction.
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Affiliation(s)
- Yanan Li
- Department of Cardiovascular Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanbin Hu
- Department of Cardiovascular Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiaxiang Wang
- Department of Cardiac Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Cardiovascular Ultrasound, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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14
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Transaortic accessory mitral valve excision in an adult patient: Case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:470-472. [PMID: 32082781 DOI: 10.5606/tgkdc.dergisi.2018.16039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/03/2018] [Indexed: 11/21/2022]
Abstract
Accessory mitral valve tissue is a rare congenital cardiac anomaly, and is usually incidentally detected in childhood. In this case, we present a 65-year-old man with aortic stenosis originating from an accessory mitral valve leaflet attached to the anterior mitral leaflet. Interestingly enough, the patient's accessory mitral valve remained undetected for years until he became symptomatic for degenerative aortic stenosis. Aortic valve replacement and excision of the accessory mitral valve attached to the anterior mitral leaflet was performed with a transaortic approach instead of atriotomy. It was also unusual to see accessory mitral valve tissue with aortic stenosis instead of other frequently associated congenital anomalies.
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15
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Rabischoffsky A, Freitas Portela ACD, Magalhães MGD, Rabischoffsky R, Zanconato JFM, Castilhos RDD, Gripp EDA. Accessory Mitral Valve Tissue: An Unusual Echocardiographic Finding. CASE 2018; 2:9-11. [PMID: 30062297 PMCID: PMC6058923 DOI: 10.1016/j.case.2017.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Kahyaoglu M, Kalayci A, Gecmen C, Sari M, Guner A, Celik M, İzgi IA, Kirma C. A rare cause of retinal artery embolism: Accessory mitral valve tissue. Echocardiography 2018; 35:258-259. [PMID: 29323754 DOI: 10.1111/echo.13795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 42-year-old female patient was referred our clinic for investigation of a history of acute retinal artery occlusion. Transthoracic echocardiography showed a cyst-like, mobile formation on posterior mitral valve leaflet. 2D and real time 3D transesophageal echocardiography showed a flexible circular mobile structure which was attached to posterior mitral valve leaflet. Echocardiographic appearance and morphological characteristics were suggestive of accessory mitral valve tissue.
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Affiliation(s)
- Muzaffer Kahyaoglu
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Arzu Kalayci
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cetin Gecmen
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Munevver Sari
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Celik
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Akin İzgi
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Cevat Kirma
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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17
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Misumi I, Nagao A, Iwamoto K, Honda T, Ishii M, Ueyama H, Maeda Y, Ishizaki M, Kurisaki R, Okazaki T, Yamashita T, Fujimoto A, Honda Y. Acute Multiple Cerebral Infarction in a Patient with an Accessory Mitral Valve. Intern Med 2017; 56:153-155. [PMID: 28090044 PMCID: PMC5337459 DOI: 10.2169/internalmedicine.56.7649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 96-year-old woman developed hemiparesis 2 weeks after orthopedic surgery. Magnetic resonance imaging revealed multiple cerebral infarctions in the bilateral hemisphere. Transthoracic echocardiography revealed a mobile structure attached to the anterior mitral leaflet that protruded toward the left ventricular outflow tract. The structure was identified as an accessory mitral valve. Doppler echocardiography showed that there was no significant left ventricular outflow obstruction. This is a rare case of a silent accessory mitral valve that was detected after multiple cerebral infarctions.
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Affiliation(s)
- Ikuo Misumi
- Department of Cardiology, Kumamoto Saisyunsou Hospital, Japan
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18
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Kato H, Escudero C, Sherwin E, Hosking M, Gandhi SK. Jellyfish-Like Accessory Mitral Valve Tissue Causing Near-Collapse in a Young Child. World J Pediatr Congenit Heart Surg 2016; 9:251-253. [PMID: 27881808 DOI: 10.1177/2150135116668335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accessory mitral valve tissue (AMVT) causing left ventricular outflow tract obstruction (LVOTO) is rare. We report a case of AMVT causing severe LVOTO resulting in acutely progressive symptoms of near-collapse. Urgent surgical resection eliminated the patient's life-threatening symptoms. AMVT should be considered among potential LVOTO diagnoses, and early surgical intervention may be required.
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Affiliation(s)
- Hideyuki Kato
- 1 Division of Cardiovascular and Thoracic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Carolina Escudero
- 2 Division of Cardiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Elizabeth Sherwin
- 2 Division of Cardiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Martin Hosking
- 2 Division of Cardiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Sanjiv K Gandhi
- 1 Division of Cardiovascular and Thoracic Surgery, BC Children's Hospital, Vancouver, British Columbia, Canada
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19
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Parato VM, Scarano M, Crosca S. A little innocent heart murmur in a child with accessory mitral valve tissue. Int J Cardiol 2016; 203:936-7. [DOI: 10.1016/j.ijcard.2015.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/26/2022]
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20
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Baxi AJ, Tavakoli S, Vargas D, Restrepo CS. Bands, Chords, Tendons, and Membranes in the Heart: An Imaging Overview. Curr Probl Diagn Radiol 2015; 45:380-391. [PMID: 26433812 DOI: 10.1067/j.cpradiol.2015.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Crests, bands, chords, and membranes can be seen within the different cardiac chambers, with variable clinical significance. They can be incidental or can have clinical implications by causing hemodynamic disturbance. It is crucial to know the morphology and orientation of normal structures, aberrant or accessory muscles, and abnormal membranes to diagnose the hemodynamic disturbance associated with them. Newer generation computed tomographic scanners and faster magnetic resonance imaging sequences offer high spatial and temporal resolution allowing for acquisition of high resolution images of the cardiac chambers improving identification of small internal structures, such as papillary muscles, muscular bands, chords, and membranes. They also help in identification of other associated complications, malformations, and provide a road map for treatment. In this article, we review cross-sectional cardiac imaging findings of normal anatomical variants and distinctive imaging features of pathologic bands, chords, or membranes, which may produce significant hemodynamic changes and clinical symptomatology.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Sina Tavakoli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Daniel Vargas
- Department of Radiology, University of Colorado Hospital, Denver, CO
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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21
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Accessory mitral valve tissue with mitral complex structural abnormality. J Echocardiogr 2015; 13:76-8. [PMID: 26069449 PMCID: PMC4454826 DOI: 10.1007/s12574-015-0245-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 04/07/2015] [Accepted: 04/29/2015] [Indexed: 11/17/2022]
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22
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Yamaguchi S, Ishikawa N, Tomita S, Ohtake H, Kiuchi R, Nishida Y, Muramatsu K, Watanabe G. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann Thorac Surg 2014; 98:1096-8. [PMID: 25193197 DOI: 10.1016/j.athoracsur.2013.10.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/13/2013] [Accepted: 10/18/2013] [Indexed: 10/24/2022]
Abstract
The presence of isolated accessory mitral valve tissue (AMVT) is extremely rare in adults. We successfully performed robot-assisted resection of dual AMVT that was attached to the papillary muscle and anterior mitral leaflet. Echocardiography was invaluable for identifying the most suitable approach. The short-axis view on echocardiography revealed the precise location where the AMVT was attached. The robotic operation enabled fine visualization; we clearly observed the AMVT and removed its entire extra structure. The patient recovered well and was discharged 3 days after the operation. To the best of our knowledge, this is the first report of successful robotic AMVT resection.
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Affiliation(s)
- Shojiro Yamaguchi
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan.
| | - Norihiko Ishikawa
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Shigeyuki Tomita
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Ohtake
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Ryuta Kiuchi
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Yuji Nishida
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Kenichi Muramatsu
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Go Watanabe
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
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23
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Hisatomi K, Hashizume K, Tanigawa K, Miura T, Matsukuma S, Yokose S, Sumi M, Eishi K. Asymptomatic and isolated accessory mitral valve tissue in an adult. Gen Thorac Cardiovasc Surg 2014; 64:105-8. [PMID: 24740639 DOI: 10.1007/s11748-014-0399-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Abstract
Accessory mitral valve (AMV) tissue is a congenital anomaly that occurs in association with other congenital anomalies, and is an uncommon cause of left ventricular outflow tract obstruction. It is usually detected in early childhood when accompanied by symptoms of obstruction of the left ventricular outflow tract, and is rarely diagnosed in adults. We present a case of a 53-year-old man who was referred to our institution for evaluation of a systolic heart murmur. Echocardiography disclosed a diagnosis of AMV tissue. This case was uncommon because of the lack of severe obstruction of left ventricular outflow, cardiac symptoms, or other cardiac anomalies. We were able to carry out surgical resection of AMV tissue to avert possible progression of aortic insufficiency and the risk of a cerebrovascular embolization. The patient's postoperative course was uneventful, and postoperative echocardiography showed no residual accessory mitral tissue.
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Affiliation(s)
- Kazuki Hisatomi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Koji Hashizume
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kazuyoshi Tanigawa
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Seiji Matsukuma
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shogo Yokose
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mizuki Sumi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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24
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Gurzun MM, Husain F, Zaidi A, Ionescu A. Accessory Mitral Valve-An Unexpected Intra-Operative TEE Finding Causing Left Ventricular Outflow Tract Obstruction in an Adult. Echocardiography 2013; 31:E55-7. [DOI: 10.1111/echo.12436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Farhan Husain
- Morriston Regional Cardiac Centre; Morriston Wales United Kingdom
| | - Afzal Zaidi
- Morriston Regional Cardiac Centre; Morriston Wales United Kingdom
| | - Adrian Ionescu
- Morriston Regional Cardiac Centre; Morriston Wales United Kingdom
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25
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Rao CM, Lucà F, Benedetto FA, Benedetto D, Parise O, Gelsomino S. Accessory mitral valve: a rare cause of asymptomatic severe left ventricular outflow tract obstruction. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:742-5. [PMID: 24200659 DOI: 10.5761/atcs.cr.13-00109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Accessory mitral valve (AMV) is an extremely uncommon congenital cardiac anomaly and it is a rare cause of left ventricular outflow tract (LVOT) obstruction. Identification of asymptomatic patients with LVOT obstruction is uncommon since the symptoms usually become manifest when the gradient across the LVOT rises. We describe a rare case of asymptomatic AMV with severe LVOT obstruction in a 10-year old child with no other congenital or acquired cardiac defects who successful underwent surgery. This case emphasizes the importance of early surgical indication also in absence of symptoms when significant LVOT obstruction occurs.
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26
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Manganaro R, Zito C, Khandheria BK, Cusmà-Piccione M, Chiara Todaro M, Oreto G, D'Angelo M, Mohammed M, Carerj S. Accessory mitral valve tissue: an updated review of the literature. Eur Heart J Cardiovasc Imaging 2013; 15:489-97. [PMID: 24165118 DOI: 10.1093/ehjci/jet163] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly sometimes responsible for left ventricular outflow tract (LVOT) obstruction. It is diagnosed during both neonate-childhood and adult periods in patients usually symptomatic for dyspnoea, chest pain, palpitations, fatigue, or syncope. Nevertheless, AMVT is often an incidental finding. AMVT is most often associated with other cardiac and vascular congenital malformations, such as septal defects and transposition of the great arteries. Surgery is indicated only in cases of significant LVOT obstruction and in patients undergoing correction of other cardiac malformations or exploration of an intracardiac mass. Two-dimensional echocardiography, both transthoracic and transoesophageal, is considered the main imaging modality for AMVT diagnosis and patient follow-up. The recent introduction of three-dimensional echocardiography allows a more realistic characterization of this entity. We present three clinical cases in which AMVT was incidentally diagnosed during standard echocardiography and an updated review of the literature highlighting the usefulness of echocardiography for AMVT morphological and functional characterization as well as the most relevant clinical implications due to its discovery.
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Affiliation(s)
- Roberta Manganaro
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Via Consolare Valeria n.12, 98100 Messina, Italy
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27
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Occlusion of the retinal artery occlusion by undiagnosed accessory mitral valve tissue. Herz 2013; 39:651-3. [DOI: 10.1007/s00059-013-3882-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
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28
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Panduranga P, Al-Mukhaini M. Isolated non-obstructive accessory mitral valve tissue in an adult mimicking ruptured chordae. Indian Heart J 2013; 65:334-6. [PMID: 23809393 DOI: 10.1016/j.ihj.2013.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/27/2013] [Accepted: 04/03/2013] [Indexed: 11/16/2022] Open
Abstract
Accessory mitral valve tissue is commonly associated with other congenital heart diseases and is usually detected in children causing left ventricular outflow tract obstruction. We present an adult patient with isolated non-obstructive accessory mitral valve tissue that was mimicking ruptured chordae of the mitral valve. Accessory mitral valve tissue in adults is very rare and can mimick various causes of left ventricular outflow tract obstruction. This patient represents the first case in literature wherein an unobstructive accessory mitral valve tissue simulated a ruptured chordae. This case illustrates that in patients with suspected mitral valve chordae rupture without any mitral regurgitation, this diagnosis should be considered, which can have therapeutic implications.
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Affiliation(s)
- Prashanth Panduranga
- Senior Specialist, Department of Adult Congenital Heart Disease, Royal Hospital, Muscat 111, Oman.
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29
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Tsugu T, Iwanaga S, Matsushita K, Tsuruta H, Dan M, Murata M, Fukuda K. Isolated accessory mitral valve tissue in an asymptomatic elderly patient. J Echocardiogr 2013; 11:100-2. [DOI: 10.1007/s12574-013-0175-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/14/2013] [Accepted: 03/26/2013] [Indexed: 11/30/2022]
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30
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Mizuno A, Koike Y, Niwa K. Four-Dimensional Visualization of Accessory Mitral Valve Tissue and Cleft Mitral Valve Movement. Echocardiography 2013; 30:E114-5. [DOI: 10.1111/echo.12098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Atsushi Mizuno
- Department of Cardiology; St. Luke's International Hospital; Tokyo; Japan
| | - Yoko Koike
- Department of Cardiology; St. Luke's International Hospital; Tokyo; Japan
| | - Koichiro Niwa
- Department of Cardiology; St. Luke's International Hospital; Tokyo; Japan
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31
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Uysal OK, Duran M, Ozkan B, Tekin K, Elbasan Z. Asymptomatic accessory mitral valve tissue diagnosed by echocardiography. Korean Circ J 2012; 42:800. [PMID: 23236337 PMCID: PMC3518719 DOI: 10.4070/kcj.2012.42.11.800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/02/2012] [Accepted: 05/07/2012] [Indexed: 11/23/2022] Open
Affiliation(s)
- Onur Kadir Uysal
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
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32
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Tamin SS, Dillon J, Aizan K, Kadiman S, Latiff HA. An accessory mitral valve leaflet causing left ventricular outflow tract obstruction and associated with severe aortic incompetence. Echocardiography 2011; 29:E34-8. [PMID: 22044509 DOI: 10.1111/j.1540-8175.2011.01543.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Syahidah Syed Tamin
- Department of Cardiology, National Heart Institute, Jalan Tun Razak, Kuala Lumpur, Malaysia.
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33
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Gaspar A, Almeida J, Marinho B, Monteiro V, Abreu A, Pinho P. Images in cardiovascular medicine. Accessory mitral valve with cordal attachments to mitral and aortic valves: an unusual cause of left ventricular outflow tract obstruction and both mitral and aortic insufficiencies. Circulation 2011; 124:e434-6. [PMID: 22025642 DOI: 10.1161/circulationaha.111.021030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- António Gaspar
- Department of Cardiology, Hospital of Braga, Braga, Portuga, Portugal.
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34
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Chaubey S, Khan H, Zaheer A, Desai J. Accessory mitral valve associated with transient ischemic attacks. J Card Surg 2011; 26:623-4. [PMID: 22017208 DOI: 10.1111/j.1540-8191.2011.01333.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Accessory mitral valve (AMV) is an unusual congenital cardiac anomaly typically presenting with left ventricular outflow obstruction. We describe a patient with AVM presenting with transient ischemic attack.
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Affiliation(s)
- Sanjay Chaubey
- Department of Cardiothoracic Surgery, Kings College Hospital, Denmark Hill, London, United Kingdom
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35
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Capdeville M, Mangi A, Lytle BW. An Unusual Cause of Left Ventricular Outflow Tract Obstruction. J Cardiothorac Vasc Anesth 2011; 25:673-7. [DOI: 10.1053/j.jvca.2010.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Indexed: 11/11/2022]
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36
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Panduranga P, Eapen T, Al-Maskari S, Al-Farqani A. Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in a post-Senning patient with transposition of the great arteries. Heart Int 2011; 6:e6. [PMID: 21977306 PMCID: PMC3184715 DOI: 10.4081/hi.2011.e6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 07/09/2011] [Accepted: 07/15/2011] [Indexed: 11/22/2022] Open
Abstract
Accessory mitral valve tissue is a rare congenital anomaly associated with congenital cardiac defects and is usually detected in the first decade of life. We describe the case of an 18-year old post-Senning asymptomatic patient who was found to have accessory mitral valve tissue on transthoracic echocardiography producing severe left ventricular outflow tract obstruction.
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37
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Musumeci B, Spirito P, Parodi MI, Assenza GE, Autore C. Congenital accessory mitral valve tissue anomaly in a patient with genetically confirmed hypertrophic cardiomyopathy. J Am Soc Echocardiogr 2010; 24:592.e5-6. [PMID: 20843659 DOI: 10.1016/j.echo.2010.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Indexed: 11/17/2022]
Abstract
Accessory mitral valve tissue is a rare congenital cardiac anomaly that was initially described in children in association with other cardiac congenital abnormalities and, more recently, has also been reported in adults. The authors report a patient with genetically confirmed hypertrophic cardiomyopathy who also had a highly mobile, free-floating membrane-like structure in contiguity with the ventricular side of the anterior mitral valve leaflet, a feature consistent with the diagnosis of accessory mitral valve tissue.
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Affiliation(s)
- Beatrice Musumeci
- Divisione di Cardiologia, Azienda Ospedaliera Sant'Andrea, II Facoltà di Medicina, Università Sapienza, Rome, Italy
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38
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Yuan SM, Shinfeld A, Mishaly D, Haizler R, Ghosh P, Raanani E. Accessory mitral valve tissue: a case report and an updated review of literature. J Card Surg 2009; 23:769-72. [PMID: 19017009 DOI: 10.1111/j.1540-8191.2008.00633.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Accessory mitral valve tissue is an unusual congenital cardiac anomaly and a rare cause responsible for left ventricular outflow tract obstruction. An 18-year-old patient was referred to this hospital due to an occasionally noted heart murmur in a medical examination. Echocardiography facilitated the diagnosis of accessory mitral valve tissue. To relieve the left ventricular outflow tract obstruction, an operation including resection of the accessory mitral valve tissue, implantation of artificial chordae tendineae, and mitral valve annuloplasty was performed successfully. Postoperative echocardiography showed a complete relief of the mitral valve leaflets and a wide patent left ventricular outflow tract. However, transient ischemic attack and Horner's syndrome complicated the patient early postoperatively. He was administered with a high dose of aspirin, and he recovered shortly. Surgical removal is in so much mandatory as a definite diagnosis of accessory mitral valve tissue with left ventricular outflow tract obstruction is established. A prophylactic treatment should be applied to the patients with accessory mitral valve tissue in virtue of their susceptibility to neurological events.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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39
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Bär H, Katus HA, Mereles D. Accessory mitral valve as a potential source of cardioembolism. Int J Cardiol 2009; 131:e76-7. [PMID: 17707535 DOI: 10.1016/j.ijcard.2007.05.107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 05/11/2007] [Indexed: 11/25/2022]
Abstract
An accessory mitral valve (AMV) is considered to arise from abnormal development of endocardial cushion tissue. It is a very rare entity, commonly diagnosed in childhood and associated with symptomatic left ventricular outflow tract (LVOT) obstruction. Here we describe the presence of AMV in a 58-year old patient who presented with a transient ischemic attack. Transesophageal echocardiography visualized a spherical structure attached to the ventricular aspect of the anterior mitral valve leaflet.
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40
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Shah JR, Deyo CN, Pagel PS. A rare cause of mitral regurgitation in an elderly man undergoing aortic valve replacement. J Cardiothorac Vasc Anesth 2008; 24:193-5. [PMID: 19101170 DOI: 10.1053/j.jvca.2008.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Jaymin R Shah
- Anesthesia Service, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI 53295, USA
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41
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Kim MS, Klein AJ, Groves BM, Quaife RA, Salcedo EE. Left ventricular outflow tract obstruction in the presence of asymmetric septal hypertrophy and accessory mitral valve tissue treated with alcohol septal ablation. ACTA ACUST UNITED AC 2008; 9:720-4. [DOI: 10.1093/ejechocard/jen152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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42
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Okada M, Kato G, Ochi Y, Nakai M. Accessory mitral valve causing left ventricular outflow tract obstruction in an adult. Gen Thorac Cardiovasc Surg 2008; 56:77-80. [PMID: 18297463 DOI: 10.1007/s11748-007-0192-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 10/12/2007] [Indexed: 11/29/2022]
Abstract
Accessory mitral valve (AMV) is a rare congenital abnormality that, rarely, causes left ventricular outflow tract (LVOT) obstruction in adults. We report the case of a 47-year-old man with deteriorating exertional dizziness. Evaluations revealed that the left ventricular outflow tract obstruction was caused by the accessory mitral valve. The patient underwent a successful operation for removal of the accessory mitral valve.
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Affiliation(s)
- Masahiro Okada
- Department of Cardiovascular Surgery, National Hospital Organization, Okayama Medical Center, 1711-1 Tamasu, Okayama, Okayama 701-1192, Japan.
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43
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Tanaka H, Okada K, Yamshita T, Nakagiri K, Matsumori M, Okita Y. Accessory mitral valve causing left ventricular outflow tract obstruction and mitral insufficiency. J Thorac Cardiovasc Surg 2006; 132:160-1. [PMID: 16798322 DOI: 10.1016/j.jtcvs.2006.01.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 01/20/2006] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroshi Tanaka
- Kobe University Hospital, Department of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe, Japan.
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