The "Polar Light Sign" is a useful tool to detect discrete membranous supravalvular mitral stenosis

Semi-mobile rudimentary tissues attached to a congenital intramitral ring in a woman with previous history of embolic stroke: A rare case report

Isolated congenital mitral ring is a very rare subtype of congenital mitral valve malformation, which accounts for about one-third of congenital cardiac anomalies associated with left ventricular inflow obstruction. A mitral ring may be easily missed unless the disease is suspected. The mitral valve repair should be considered in symptomatic patients with mitral stenosis. We report a rare case of a 43-year-old woman with an intramitral ring who experienced previous embolic stroke with left hemiplegia. However, stroke happened several years ago and it does not completely prove causality.

Supravalvar mitral ring with a parachute mitral valve and subcoarctation of the aorta in a child with hemodynamically significant VSD. A study of the morphology, echocardiographic diagnostics and surgical therapy

The authors present a case of echocardiographic diagnosis of supravalvar mitral ring (a fibromembranous structure that arose from the atrial surface of the mitral leaflets) in a child with a parachute mitral valve, a ventricular septal defect, and mild narrowing of the aortic isthmus. The supravalvar mitral stenosis is a typical but very infrequently detected element of the complex of anatomical abnormalities located within the left heart and the proximal aorta, called the Shone’s complex (syndrome). Diagnosing an additional, hemodynamically significant anatomic defect during echocardiography was possible thanks to the detection of marked mobility limitation of the ring-adjacent part of the mitral valve mural leaflet as well as of an atypical image of turbulence occurring during the inflow from the left atrium to the left ventricle. The early diagnosis made it possible to perform complete correction of this complex congenital defect within a single operation.

Tetralogy of Fallot associated with supramitral ring: "Paying for a near miss"

A 13-year-old girl developed the features of congestive heart failure on day three of intracardiac repair of tetralogy of Fallot. A routine transthoracic echocardiography identified the missed supramitral ring (SMR), closely placed just above the mitral valve, the very reason for severe mitral stenosis and its implication in the present clinical deterioration. A rare association of SMR with tetralogy of Fallot may be missed narrowly because closely placed SMR can sometimes mask its hemodynamic effect when present with significant right ventricular outflow tract obstruction as in this case. <Learning objective: This case report highlights when a case of complex congenital heart disease is referred for intervention or surgery, it is better to be verified by a pediatric cardiologist. Tetralogy of Fallot (TOF) associated with supramitral ring (SMR) is reported as an anecdotal case report. Although it is a mistake, it may be possible to miss the SMR when it is associated with TOF. The reasons are threefold: (1) The rare association of SMR with TOF. (2) The close proximity of SMR to mitral valve. (3) Right ventricular outflow obstruction in TOF reduces flow across mitral valve i.e. a low cardiac output state.>.

Mid-Term Results of Congenital Supravalvar Mitral Ring Resection

BACKGROUND

Supravalvar mitral ring is a rare congenital anomaly leading to left ventricle inflow obstruction. We present our surgical experience and mid-term results in patients operated for supravalvar mitral ring and associated congenital heart defects.

MATERIALS AND METHODS

A retrospective analysis was performed in order to evaluate the cases surgically treated with the diagnosis of supravalvar mitral ring between 2001 and 2014. Ten patients were identified, seven of whom had accompanying congenital heart defects. Median age at the operation was 4.5 years.

RESULTS

Ventricular septal defects were encountered in half of the cases. Two of the patients had mitral annular hypoplasia, another two had the components of Shone's complex. The mean preoperative gradient across the supravalvar mitral ring decreased from 14.1 ± 4.2 mmHg to 4.6 ± 2.2 mmHg. All patients are alive and remain in a good clinical condition after a mean follow-up of five years.

CONCLUSION

Supravalvar mitral ring is a surgically treatable cause of left ventricular inflow obstruction. Although residual gradients may be encountered in patients with mitral annular hypoplasia, surgical resection of the ring is encouraged.