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Sinha SK, Mishra V, Singh K, Asif M, Sachan M, Kumar A, Jha MJ, Khanra D, Singh AK, Singh S, Razi M, Thakur R, Pandey U, Varma CM. Bi-Luminal Mitral Valve: Incidence, Clinical Features, Associated Anomaly and Echocardiographic Evaluation. J Clin Med Res 2016; 8:893-898. [PMID: 27829956 PMCID: PMC5087630 DOI: 10.14740/jocmr2790w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the study was to know the incidence, clinical features, associated anomaly and echocardiographic evaluation of bi-luminal mitral valve (also known as double orifice mitral valve or DOMV) in patients with suspected mitral valve disease, continous murmur or left-to-right shunt. Methods Twenty-eight patients with DOMV were diagnosed by transthoracic echocardiography (TTE) in a retrospective review of 52,256 echocardiographic studies in 45,898 patients performed between 2000 and 2015. Results The mean age was 20.1 years (15 - 34 years) with female preponderance (M/F: 1:1.8). Dyspnea and diastolic murmur were the most common symptoms found in 19 (67.8%) and 19 (67.8%) of patients, respectively. Normal sinus rhythm was the most common electrocardiographic finding. Twenty-five (89%) patients had complete bridge, while three (11%) had incomplete bridge type of DOMV. Twenty-one (75%) had severe mitral stenosis (MS) including severe tricuspid regurgitation (n = 13, 61%), ventricular septal defect (VSD, n = 3, 14%), complete endocardial cushion defect (ECD, n = 3, 14%), and mild to moderate mitral regurgitation (MR) (n = 2, 11%), moderate MS and moderate MR were found in four (16%) patients among complete bridge type of DOMV, while all patients with incomplete bridge type had severe MS and patent ductus arteriosus (PDA) as associated lesions. Overall, 24 (85%) had severe and four (15%) had moderate MS. Conclusions DOMV as a cause of symptomatic mitral valve disease was seen in young and middle-aged patients with estimated incidence of 0.06%. Dyspnea and diastolic murmur were the most common symptoms. Mostly, it was an isolated anomaly but in majority, associated with VSD, complete ECD and PDA. TTE examination is a reliable and sufficient means of diagnosing DOMV and determining its type.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vikas Mishra
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohammad Asif
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ashutosh Kumar
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mukesh Jitendra Jha
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Dibbendhu Khanra
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Avinash Kumar Singh
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Shravan Singh
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mahamdula Razi
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
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Tandon R, Takkar S, Kumbhkarni S, Kumar N, Aslam N, Mohan B, Wander GS. A rare case of double orifice mitral valve with perimembranous ventricular septal defect: Application of three-dimensional echocardiography for clinical decision making. Ann Pediatr Cardiol 2010; 3:87-9. [PMID: 20814484 PMCID: PMC2921527 DOI: 10.4103/0974-2069.64362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Double orifice mitral valve (DOMV) is an uncommon anomaly of surgical importance characterized by a mitral valve with a single fibrous annulus with two orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. Associated congenital heart defects are common, though DOMV can occur as an isolated anomaly. Two-dimensional echocardiography is useful for diagnosis but combining it with real-time three-dimensional echocardiography helps in a more detailed evaluation of mitral valve and subvalvular structures as is shown in this case description.
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Affiliation(s)
- Rohit Tandon
- Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Tagore Nagar, Civil Lines, Ludhiana, India
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Zhu D, Chen A, Zhao Q. Surgical repair for isolated congenital double-orifice mitral valve. Eur J Cardiothorac Surg 2010; 39:268-70. [PMID: 20619669 DOI: 10.1016/j.ejcts.2010.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Revised: 05/17/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022] Open
Abstract
Congenital double-orifice mitral valve is a rare congenital heart disease and causes mitral-valve regurgitation and/or stenosis. We present a case of congenital double-orifice mitral valve with mitral regurgitation that was not verified by preoperative echocardiography. It was confirmed by open-heart surgery and was successfully repaired with comprehensive techniques. It is possible to achieve better long-term results and life quality of congenital double-orifice mitral valve with valve repair.
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Affiliation(s)
- Dan Zhu
- Division of Cardiac Surgery of Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, PR China
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Kim SJ, Shin ES, Lee SG. Congenital double-orifice mitral valve with mitral regurgitation due to flail leaflet in an elderly patient. Korean J Intern Med 2005; 20:251-4. [PMID: 16295786 PMCID: PMC3891162 DOI: 10.3904/kjim.2005.20.3.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Accepted: 02/28/2005] [Indexed: 11/27/2022] Open
Abstract
We report here on a case of double-orifice mitral valve with mitral regurgitation in a 75-year-old female who had complaints of mild dyspnea. Transthoracic and transesophageal echocardiography showed two orifices that were supplied by their own chordae from a different papillary muscle. Color Doppler echocardiography revealed moderate to severe mitral regurgitation due to the flail posterior leaflet of the anterolateral orifice. Except for the persistent left superior vena cava, no other congenital anomaly was demonstrated. The patient became asymptomatic with the administration of angiotensin-converting enzyme inhibitor and diuretics, and she has been scheduled for long term follow-up.
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Affiliation(s)
- Shin-Jae Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Eun-Seok Shin
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang-Gon Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Shiran A, Lewis BS. Acquired partially flail leaflet causing severe mitral regurgitation in a congenital double-orifice mitral valve. J Am Soc Echocardiogr 2004; 17:478-9. [PMID: 15122192 DOI: 10.1016/j.echo.2004.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Double orifice mitral valve is a rare congenital malformation. We report a 48-year-old woman with new onset congestive heart failure and mitral regurgitation. Transesophageal echocardiography showed a partially flail mitral valve and severe mitral regurgitation. A deep transgastric view showed a double orifice mitral valve with a smaller accessory anterolateral orifice, and identified the origin of the regurgitant jet from the larger posteromedial orifice.
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Affiliation(s)
- Avinoam Shiran
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Erdemli Ö, Ayik İ, Karadeniz Ü, Yamak B, Levent Birincioğlu C, Çağlar K. A double-orifice atrioventricular valve case: intraoperative transesophageal echocardiography in diagnosis and treatment. Anesth Analg 2003; 97:650-653. [PMID: 12933377 DOI: 10.1213/01.ane.0000078580.22176.b0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a 45-yr-old woman with an intermediate type atrioventricular septal defect associated with a double-orifice left atrioventricular valve (DOLAV). We diagnosed this exceptional anomaly by intraoperative transesophageal echocardiography (TEE) during surgery that was scheduled for only a primum type atrial septal defect (ASD) repair. Preoperative transthoracic echocardiography and angiography revealed the ASD but could not demonstrate the DOLAV. We were able to repair this rare and challenging abnormality successfully under the guidance of TEE imaging during the operation. TEE provides valuable information about both anatomy and functional aspect of the valvular structures. Besides its proven role in cardiac surgery, intraoperative use of TEE also serves as a useful tool for diagnosis of such unexpected and potentially missed abnormalities.
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Affiliation(s)
- Özcan Erdemli
- *Department of Anesthesiology and Reanimation and †Cardiovascular Surgery, Türkiye Yüksek İhtisas Hospital, Sihhiye-Ankara
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Karas S, Barbetseas J, Lambrou S, Parissis J, Metzikof D, Toutouzas P. Well-functioning double-orifice mitral valve in a young adult. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:170-173. [PMID: 12594805 DOI: 10.1002/jcu.10142] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
We report the case of a rare congenital anomaly, a double-orifice mitral valve, in a 23-year-old woman who was asymptomatic and had no history of heart disease. Transthoracic and multiplane transesophageal echocardiography revealed 2 functionally normal orifices of equal size, the least frequent anatomic presentation of this anomaly. We prescribed antibiotic prophylaxis because of the concomitant presence of a mildly stenotic bicuspid aortic valve and recommended annual follow-up examinations to monitor both lesions for possible progression.
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Affiliation(s)
- Spilios Karas
- Department of Cardiology, Amalia Fleming Hospital, 14 March 25th Street, Athens 15127, Greece
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Yesilbursa D, Miller A, Nanda NC, Mukhtar O, Huang WY, Ansingkar K, Puri V, Bourge RC, Hsiung M, McGiffin DC. Echocardiographic diagnosis of a stenotic double orifice parachute mitral valve with a single papillary muscle. Echocardiography 2000; 17:349-52. [PMID: 10979006 DOI: 10.1111/j.1540-8175.2000.tb01149.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We present the case of a patient with a single papillary muscle that is supporting both orifices of a stenotic double orifice mitral valve. With the use of both transthoracic and transesophageal echocardiography, we were able to prospectively define this entity, which was confirmed at surgery.
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Affiliation(s)
- D Yesilbursa
- University of Alabama at Birmingham, Heart Station SW/S102, Birmingham, AL 35249, USA
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Goldberg N, Schifter D, Aron M, Shapiro RS, Krasnow N, Stein RA. Double Orifice Mitral and Tricuspid Valves. Echocardiography 1996; 13:85-90. [PMID: 11442908 DOI: 10.1111/j.1540-8175.1996.tb00872.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Atrioventricular valve duplication is a rare congenital cardiac anomaly. The anomaly is usually recognized as an incidental finding at autopsy, open heart surgery, or two-dimensional echocardiography. In this article we present the transthoracic and transesophageal presentation of a case of mitral and a case of tricuspid valve duplication. The hemodynamic consideration of the lesions is discussed with a review of the literature. (ECHOCARDIOGRAPHY, Volume 13, January 1996)
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Affiliation(s)
- Nieca Goldberg
- SUNY Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 1199, Brooklyn, NY 11203
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