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Damlakhy A, Messina Alvarez AA, Martin RH, Hakim AH, Rajagopal R. Non-syndromic Parachute Mitral Valve "When the Valve Dives in": Case Report and Review of the Literature. Cureus 2024; 16:e52805. [PMID: 38389617 PMCID: PMC10883408 DOI: 10.7759/cureus.52805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
A parachute mitral valve (PMV) is a congenital mitral valve anomaly diagnosed in infancy, and it can also be discovered in adults during echocardiography. Surgical management is common in infants to prevent complications from left-heart obstructions. In adults, PMV may be found independently or with other cardiac defects. Prophylactic antibiotics are recommended for certain congenital heart anomalies before dental procedures. A study suggests reconsidering guidelines to include anomalies like bicuspid aortic valve and MVP for antibiotic prophylaxis. PMV, with transvalvular blood flow turbulence, may increase the risk of infective endocarditis, as seen in a reported case with a parachute-like mitral valve. Here, we present the case of a 62-year-old female incidentally found to have a PMV during an echocardiogram.
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Affiliation(s)
- Ahmad Damlakhy
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | - Angelo A Messina Alvarez
- Internal Medicine, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
| | | | - Arif H Hakim
- Cardiology, Detroit Medical Center, Detroit, USA
| | - Ramegowda Rajagopal
- Cardiology, Detroit Medical Center/Sinai Grace Hospital/Wayne State University, Detroit, USA
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Datt V, Khurana P, Aggarwal S, Mishra S, Sujith CN, Virmani S. Perioperative management of a patient with double orifice mitral valve with supramitral ring with subaortic membrane with ventricular septal defect and severe pulmonary hypertension: Report of a rare case. Ann Card Anaesth 2019; 22:215-220. [PMID: 30971608 PMCID: PMC6489406 DOI: 10.4103/aca.aca_123_18] [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] [Indexed: 11/04/2022] Open
Abstract
Double-orifice mitral valve (DOMV) is an unusual congenital anomaly characterized by a mitral valve with a single fibrous annulus with two orifices or rarely two orifices with two separate mitral annuli opening into the left ventricle. We present a first report of a patient with a DOMV with supramitral ring (SMR), subaortic membrane (SAM), a large ventricular septal defect (VSD) with more than 50% aortic override, and severe pulmonary arterial hypertrophy (PAH). This patient underwent excision of the SAM, and SMR, with closure of the VSD together under cardiopulmonary bypass (CPB). However postoperatively, the patient developed an irreversible fatal pulmonary hypertensive crisis (PHC), immediately after transferring the patient to the cardiac intensive care unit from the operating room (OR). The PHC was refractory to intravenous and inhaled milrinone and nitroglycerine and intravenous adrenaline, dobutamine, norepinephrine, vasopressin, patent foramen oval (PFO), and CPB support. The management of DOMV and perioperative pulmonary hypertension is discussed.
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Affiliation(s)
- Vishnu Datt
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
| | - Priyanka Khurana
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
| | - Saket Aggarwal
- Department CTVS, GB pant Hospital (GIPMER), New Delhi, India
| | - Smita Mishra
- Department of Cardiology, Jaypee Hospital, New Delhi, India
| | - C N Sujith
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
| | - Sanjula Virmani
- Department of Anaesthesiology and Intensive Care and Cardiothoracic and Vascular Surgery and Cardiology, GB Pant Hospital (GIPMER) and Jaypee Hospital, New Delhi, India
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Gorgulu S, Celik S, Eksik A, Tezel T. Double-Orifice Mitral Valve Associated with Nonisolated Left Ventricular Noncompaction. Angiology 2016; 55:707-10. [PMID: 15547659 DOI: 10.1177/00033197040550i614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Double-orifice mitral valve is a rare congenital anomaly. Although it is more frequently associated with other cardiac abnormalities, it may occur as an isolated lesion. There are 2 forms of myocardial noncompaction: isolated and nonisolated myocardial noncompaction. Nonisolated myocardial noncompactions are occasionally reported postnatally in association with congenital heart anomalies such as ventricular septal defect, pulmonic stenosis, and atrial septal defect. To our knowledge, this is the first case presentation reporting a double-orifice mitral valve associated with nonisolated myocardial noncompaction.
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Affiliation(s)
- Sevket Gorgulu
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Department, Istanbul, Turkey.
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Kim IC, Cho YK, Kim H, Park NH, Kim KB. Three-dimensional echocardiographic reconstruction of double-orifice mitral valve and mitral leaflet prolapse. Circulation 2014; 130:e87-8. [PMID: 25210099 DOI: 10.1161/circulationaha.114.011373] [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] [Indexed: 11/16/2022]
Affiliation(s)
- In-Cheol Kim
- From the Division of Cardiology, Department of Internal Medicine (I.-C.K., Y.-K.C., H.K., K.-B.K.), and the Department of Thoracic Cardiovascular Surgery (N.-H.P.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Yun-Kyeong Cho
- From the Division of Cardiology, Department of Internal Medicine (I.-C.K., Y.-K.C., H.K., K.-B.K.), and the Department of Thoracic Cardiovascular Surgery (N.-H.P.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea.
| | - Hyungseop Kim
- From the Division of Cardiology, Department of Internal Medicine (I.-C.K., Y.-K.C., H.K., K.-B.K.), and the Department of Thoracic Cardiovascular Surgery (N.-H.P.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Nam-Hee Park
- From the Division of Cardiology, Department of Internal Medicine (I.-C.K., Y.-K.C., H.K., K.-B.K.), and the Department of Thoracic Cardiovascular Surgery (N.-H.P.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Kwon-Bae Kim
- From the Division of Cardiology, Department of Internal Medicine (I.-C.K., Y.-K.C., H.K., K.-B.K.), and the Department of Thoracic Cardiovascular Surgery (N.-H.P.), Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
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Lee GY, Chang SA, Park SW. Double orifice mitral valve with bicuspid aortic valve in real time three-dimensional transesophageal echocardiographic examination. Echocardiography 2012; 29:E253-4. [PMID: 22747508 DOI: 10.1111/j.1540-8175.2012.01770.x] [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)
- Ga Yeon Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shiraishi M, Yamaguchi A, Adachi H. Successful surgical repair of the parachute mitral valve with mitral valve regurgitation. Ann Thorac Cardiovasc Surg 2012; 18:569-72. [PMID: 22673551 DOI: 10.5761/atcs.cr.11.01841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.
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Affiliation(s)
- Manabu Shiraishi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan.
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Hakim FA, Kendall CB, Alharthi M, Mancina JC, Tajik JA, Mookadam F. Parachute Mitral Valve in Adults-A Systematic Overview. Echocardiography 2010; 27:581-6. [DOI: 10.1111/j.1540-8175.2009.01143.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Wang XX, Song ZZ. A combination of left ventricular noncompaction and double orifice mitral valve. Cardiovasc Ultrasound 2009; 7:11. [PMID: 19272135 PMCID: PMC2662788 DOI: 10.1186/1476-7120-7-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 03/09/2009] [Indexed: 11/10/2022] Open
Abstract
A 24-year-old woman admitted with mild chest distress associated with activity without chest complaint for twenty days. Two orifices were visible at the level of the mitral valve with a transthoracic short-axis view of the two-dimensional and three-dimensional echocardiography. The left ventricle was mildly dilatated and the left ventricular wall was thickened, especially at the apex and anterolateral wall, and appeared sponge-like. There were numerous, excessively prominent trabeculations associated with intertrabecular recesses. Although the coexistence of NVM and DOMV could be a coincidence, we believe that both defects were probably caused by a developmental arrest of the left ventricular myocardium in the present case.
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Affiliation(s)
- Xing-Xiang Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Ze-Zhou Song
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
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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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