'Parachute' accessory mitral leaflet and pulmonary valve stenosis in an asymptomatic 85-year-old man

Parachute mitral valve: Morphology and surgical management

Background

This review aims to discuss morphology and surgical management of parachute mitral valve.

Methods

A total of 62 articles in the English language with 330 parachute mitral valve patients were retrieved from the PubMed, HighWire Press, and Cochrane Library databases using specific MeSH terms and keywords between January 2000 and December 2018. In these articles, morphology of parachute mitral valve and surgical treatment options were investigated.

Results

A non-syndromic parachute mitral valve was present in 287 patients (87.0%) and a syndromic parachute mitral valve was present in 43 patients (13.0%). A higher number of patients with a non-syndromic parachute mitral valve presented with congestive heart failure compared to syndromic ones. The patients with a non-syndromic parachute mitral valve often had mitral regurgitation, while syndromic parachute mitral valve patients often had mitral stenosis.

Conclusion

Parachute mitral valves are usually not an isolated lesion and are often characterized by a constellation of pathological changes of the mitral valve leaflets, annulus, commissures, subvalvular apparatus, and supravalvular mitral ring. Therefore, the majority of the patients need one or more surgical operations. The incidence of adverse events such as reintervention, postoperative complete heart block, and mortality is high in these patients.

Accessory mitral valve in an elderly man on maintenance hemodialysis

This report describes a case of accessory mitral valve in an elderly patient on maintenance hemodialysis. Transesophageal echocardiography revealed a mobile sac-like structure with size of 12 × 10 mm(2), which attached to the left ventricular surface of base of the anterior mitral valve leaflet. Mobile stick-like structure with diameter of 21 mm was extending from this sac-like structure toward the left ventricular outflow tract and had a floating free edge. Peak pressure gradient across the left ventricular outflow tract was 32 mmHg. There were no other congenital cardiac anomalies. No clinical findings suggestive of bacterial or nonbacterial vegetation were seen. Also other possibilities of mobile thrombus or calcification were unlikely. These abnormal structures were diagnosed as accessory mitral valve with rudimentary chordae.