A Trileaflet “Mitral Valve” with Three Papillary Muscles: Brand New Echocardiographic Finding

Abstract

Congenital mitral valve malformations are rare, but are well known and described entities. Mitral valve malformations involve mitral valve apparatuses (leaflets and annulus) and subvalvar apparatuses (chordae and papillary muscle). Case reports of accessory mitral leaflets were already described, but were usually an appendix of the normal valve. We describe here a case report and present the images of a trileaflet mitral valve sustained by three papillary muscles in a young girl with subaortic stenosis.

Trileaflet Mitral Valve with Three Papillary Muscles Associated with Hypertrophic Cardiomyopathy: A Novel Case

“…1A), no significant left ventricular outflow tract obstruction at rest (baseline peak systolic and mean pressure gradients of 18 mmHg and 9 mmHg, respectively, and of 25 mmHg and 12 mmHg, respectively, during Valsalva maneuver), normal cardiac dimensions and systolic function with a mild-to-moderate mitral regurgitation. 8,9 The three leaflets were coupled to three separate evenly spaced and roughly equal in size papillary muscles ( Fig. 1B,C; movie clip S1).…”

“…8 Bearing in mind the association with hypertrophic cardiomyopathy, another solo case of trileaf-let MV with a direct papillary muscle insertion into the "anterior-septal" mitral leaflet in absence of three distinct papillary muscles has been described in a symptomatic female octogenarian with no prior cardiac history. 8 Bearing in mind the association with hypertrophic cardiomyopathy, another solo case of trileaf-let MV with a direct papillary muscle insertion into the "anterior-septal" mitral leaflet in absence of three distinct papillary muscles has been described in a symptomatic female octogenarian with no prior cardiac history.…”

“…To the best of the authors' knowledge, it has been reported only once in association with subaortic valvular stenosis. 8 We hereby describe a novel case associated with hypertrophic cardiomyopathy.…”

“…1,2 In a transthoracic 2D echocardiographic color Doppler study compared with data obtained by cineangiography, cardiac surgery, and autopsy, congenitally malformed MVs were detected in 65 (0.5%) subjects of the 13 400 cases examined over a 7.5-year period. 8 We hereby describe a novel case associated with hypertrophic cardiomyopathy. [1][2][3][4][5][6][7] A trileaflet MV with three separate papillary muscles with concordant atrioventricular and ventricle-arterial connections is exceptionally rare.…”

Hendidura de velo posterior que simula una válvula mitral de tres velos

“…Este es un hallazgo muy infrecuente, con una prevalencia del 0.11% en una serie de, aproximadamente, 20.000 ecocardiografías de superficie 1 , siendo reportada su semejanza con una válvula mitral de tres velos genuina 2 . Esta patología se ha reportado tanto en la edad adulta en el contexto de miocardiopatía hipertrófica 3 y membranas subaórticas 4 , como en la edad pediátrica, como una anomalía aislada y que puede ocasionar obstrucción al tracto de salida del ventrículo izquierdo y muerte súbita 5 .…”