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Alkathiri A, Anwar AM, Nosir YFM, Alcid S. Value of Three-Dimensional Echocardiography in Assessing Double-Orifice Mitral Valve in an Asymptomatic Patient. J Cardiovasc Echogr 2021; 30:214-216. [PMID: 33828944 PMCID: PMC8021078 DOI: 10.4103/jcecho.jcecho_51_19] [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: 10/01/2019] [Revised: 08/17/2019] [Accepted: 09/19/2019] [Indexed: 11/05/2022] Open
Abstract
Double-orifice mitral valve (DOMV) is a rare congenital anomaly consisting of an accessory bridge of fibrous tissue, which divides the mitral valve (MV) into two orifices. The mitral leaflets are essentially normal in most cases, but they can be regurgitant or stenotic. It is most commonly associated with a variety of other cardiac anomalies. Isolated DOMV with normal MV function is very rare. We present here a rare case of congenital DOMV in a 25-year-old female diagnosed by real-time three-dimensional echocardiography (RT3DE). RT3DE enabled complete anatomical and functional assessment of MV apparatus. It added much valuable information over conventional 2DE that helped in establishment of the diagnosis, identification of the anatomical type, and selection of the proper management.
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Affiliation(s)
- Alaa Alkathiri
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ashraf M Anwar
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Youssef F M Nosir
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.,Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Schurlyn Alcid
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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2
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Pratap H, Gupta A, Acharya PK, Mahajan V. Double orifice mitral valve: A rare cause of isolated severe congenital mitral regurgitation. Ann Pediatr Cardiol 2020; 13:174-176. [PMID: 32641896 PMCID: PMC7331838 DOI: 10.4103/apc.apc_133_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/15/2019] [Accepted: 12/06/2019] [Indexed: 12/04/2022] Open
Abstract
Double orifice mitral valve (DOMV) is a rare congenital anomaly of the mitral valve apparatus consisting of an accessory bridge of fibrous tissue, which partially or completely divides the mitral valve into two orifices. It usually occurs as an associated lesion. Encountering a DOMV as an isolated finding meriting intervention is indeed rare. We, here, report a case of “complete bridging type DOMV” occurring as an isolated entity and presenting as severe congenital MR requiring surgery.
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Affiliation(s)
- Himanshu Pratap
- Department of Pediatric Cardiac Surgery, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Amol Gupta
- Department of Pediatric Cardiology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Pradipta Kumar Acharya
- Department of Pediatric Cardiac Intensive Care, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Viresh Mahajan
- Department of Pediatric Cardiology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
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3
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Pires N, Li W, Senior R, Khattar RS. Incidental finding of a double orifice mitral valve in an elderly patient: value of 3D imaging. Echo Res Pract 2017; 4:K21-K24. [PMID: 28743714 PMCID: PMC5574279 DOI: 10.1530/erp-17-0023] [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] [Received: 07/22/2017] [Accepted: 07/25/2017] [Indexed: 11/08/2022] Open
Abstract
A rare isolated double orifice mitral valve (DOMV) was diagnosed in a 77-year-old male patient, being assessed for surgical repair of the ascending aorta. This is a rare congenital abnormality, usually discovered as an incidental finding during investigation of other congenital heart defects. This case shows that a detailed assessment of all cardiac structures is necessary, not only in young patients, but also in the elderly population, to minimise the under-diagnosis of such rare anomalies. The use of 3D transthoracic echocardiography (TTE) has an increasingly significant role in establishing the diagnosis and extending the morphological and functional understanding of the anomaly.
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Affiliation(s)
- Nuno Pires
- Department of Echocardiography, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical research Unit, Royal Brompton Hospital and Imperial College, London, UK
| | - Wei Li
- Department of Echocardiography, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical research Unit, Royal Brompton Hospital and Imperial College, London, UK
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, UK.,Cardiovascular Biomedical research Unit, Royal Brompton Hospital and Imperial College, London, UK
| | - Rajdeep S Khattar
- Department of Echocardiography, Royal Brompton Hospital, London, UK .,Cardiovascular Biomedical research Unit, Royal Brompton Hospital and Imperial College, London, UK
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4
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Ando K, Tomita Y, Masuda M, Nakashima A, Tominaga R. Repair for a duplicate mitral valve with torn chordae. J Thorac Cardiovasc Surg 2007; 134:1062-3. [PMID: 17903539 DOI: 10.1016/j.jtcvs.2007.04.036] [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: 01/18/2007] [Revised: 03/21/2007] [Accepted: 04/20/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Kohei Ando
- Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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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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6
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Mao JT, Tang J, Li Y, Sun P. Double-orifice mitral valve with multiple papillary muscles--a report of two patients. Angiology 1999; 50:771-5. [PMID: 10496505 DOI: 10.1177/000331979905000912] [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: 11/16/2022]
Abstract
Two patients with double-orifice mitral valve, in addition to ventricular septal defect in one patient and mitral insufficiency in the other, and multiplicity of left-ventricle papillary muscles are reported.
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Affiliation(s)
- J T Mao
- Ultrasound Departments of the First and Second Jilin Chemical Industrial Group Hospital and Second Clinic School, Jilin Medical College, Jilin City, PR China.
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Fernando Iglesias L, de Tomás Labat E, Valdesuso Aguilar R, Albertos Salvador J, Lafuente Gormaz C, Beltrán Beltrán S. Doble orificio valvular mitral: insuficiencia severa secundaria a rotura de cuerdas. Rev Esp Cardiol (Engl Ed) 1999. [DOI: 10.1016/s0300-8932(99)74982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Double-orifice mitral valve is an unusual condition of importance to surgeons, and usually associated with other cardiac anomalies. This article reports a case of isolated double-outlet mitral valve with torn chordae in which we successfully performed mitral valvuloplasty by placement of artificial chordae. The mitral valve was divided into anterolateral and posteromedial orifices by vertical bridging tissue. Two torn chordae at the posteromedial scallop surrounding the posteromedial mitral orifice were replaced with artificial chordae of two pairs of expanded polytetrafluoroethylene sutures. Because replacement of torn chordae with artificial chordae was not complicated and seemed to preserve very fine relationships among leaflet tissues, bridging tissue, chordae, and papillary muscles, we suggest this method may be used to reconstruct various kinds of mitral lesions causing mitral regurgitation.
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Affiliation(s)
- Y Tomita
- Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
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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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Hoffman P, Stümper O, Groundstroem K, Sutherland G. The transesophageal echocardiographic features of double-orifice left atrioventricular valve. J Am Soc Echocardiogr 1993; 6:94-100. [PMID: 8439430 DOI: 10.1016/s0894-7317(14)80263-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Three adult patients with a double-orifice left atrioventricular valve (AV) were studied by both precordial and transesophageal ultrasound imaging, (two transverse plane and one biplane studies) to compare and contrast the information obtained by either imaging modality. In two patients, this pathologic condition was associated with other congenital heart malformations--a muscular inlet ventricular septal defect in the first, atrioventricular and ventriculoarterial discordance and an unrestrictive ventricular septal defect in the second. In the third patient, the double-orifice left AV valve existed as an isolated lesion. In the first and second case, both orifices were of similar size; in the third the additional orifice was of diminutive size and was demonstrated only by transesophageal longitudinal plane scanning. In summary, in this adult patient group, transesophageal echocardiography with color flow mapping was superior to precordial scanning in the assessment of both the morphology and functional status of a double-orifice left AV.
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Affiliation(s)
- P Hoffman
- Department of Cardiology, Western General Hospital, Edinburgh, Scotland
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Park IS, Yoo SJ, Kim KS, Hong CY. Tricuspid atresia associated with double-orifice mitral valve and coronary sinus septal defect. Tex Heart Inst J 1991; 18:202-5. [PMID: 15227481 PMCID: PMC324998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Clinical, echocardiographic, and angiographic findings of a very rare case of cardiac malformation are presented. The main features were tricuspid atresia, coronary sinus septal defect, and double-orifice mitral valve. These defects were correctly diagnosed by echocardiography and were confirmed by angiocardiography.
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Affiliation(s)
- I S Park
- Department of Pediatrics and Radiology, Asan Medical Center, Ulsan University Medical School, Seoul, Korea
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Baño-Rodrigo A, Van Praagh S, Trowitzsch E, Van Praagh R. Double-orifice mitral valve: a study of 27 postmortem cases with developmental, diagnostic and surgical considerations. Am J Cardiol 1988; 61:152-60. [PMID: 3276118 DOI: 10.1016/0002-9149(88)91322-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
What is double-orifice mitral valve anatomically and embryologically? In 27 postmortem cases, an anomaly of the tensor apparatus was always found. These malformations may be summarized as: (1) chordal ring; (2) accessory papillary muscle or muscles; (3) subdividing muscular ridge; (4) fused papillary muscles (parachute mitral valve); (5) crossing chordae tendineae; and (6) central fibrous subdivision. More than 1 of these anomalies often coexisted per case. Double-orifice mitral valve almost always consisted of abnormal holes in essentially normal leaflets, rather than of abnormal fibrous bridges or adhesions between normal leaflets. Since these fibrous "bridges" between the smaller accessory orifice and the larger main orifice are composed of mitral leaflet tissue and chordae, not fibrous adhesions, these bridges should not be transected surgically, to avoid iatrogenic mitral regurgitation. The accessory (smaller) orifice was at the anterolateral commissure in 11 cases (41%), at the posteromedial commissure in 12 (44%) and there was a central fibrous subdivision with approximately equal-sized orifices in 4 (15%). The atrioventricular (AV) canal was normally divided in 12 cases (44%) and a common AV canal was present in 15 (56%). When the accessory orifice was at the anterolateral commissure, the AV canal usually was normally divided (8 of 11, 73%). But when the accessory orifice was at the posteromedial commissure, a common AV canal almost always was present (11 of 12, 92%). Functionally, the mitral valve was normal in 13 (48%), regurgitated in 7 (26%) and stenotic in 7 (26%). The key to the diagnostic and surgical understanding of the double-orifice mitral valve is the underlying tensor apparatus.
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Affiliation(s)
- A Baño-Rodrigo
- Department of Pathology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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