Cleft posterior mitral leaflet resembling a tri-leaflet mitral valve: a novel phenotypic association with hypertrophic cardiomyopathy

Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging

“…The typical cleft is a gap at the middle of anterior leaflet, but it has been long known that rarely posterior leaflet may be affected by such true cleft involving central tissue gap 9. Diagnosis of this typical pattern of congenital cleft mitral valve was recently enhanced by 3DTOC 10 11 22. However, use of the term ‘cleft’ in describing indentations between posterior leaflet scallops, normal or exaggerated,14 has been confusing.…”

“…However, use of the term ‘cleft’ in describing indentations between posterior leaflet scallops, normal or exaggerated,14 has been confusing. Hence, we believe, it is essential to separate nosologically CLI from true clefts affecting the posterior leaflet 9 11 12. In terms of diagnosis, 2DTEE may have difficulty ascertaining typical cleft despite multiplane imaging23 24 with even more difficulty with CLI, so that CLI identification is essential in demonstrating 3DTOC usefulness 8.…”

“…True posterior leaflet clefts, cleaving it in two equal remnants, while long-known,9 are rare, but have recently been diagnosed in vivo with 3DTOC 10 11. Lately, another feature of MMVD was described: deep ‘clefts’ of posterior mitral leaflet,12 which do not really cleave the leaflet, but occupy the position of normal indentations between its three scallops.…”

Thymic Neuroendocrine Carcinoma – A Case of Malignant Men 1 Tumour Disguised as Hyperparathyroidism

“…Whilst an association between HCM and trileaflet mitral valves has been described previously, in this case the diagnosis of HCM that later did not demonstrate progression of LV hypertrophy or increase in outflow gradient was a mischaracterisation of concurrent hypertensive cardiomyopathy with complex MR caused by the trileaflet mitral valve [2][3][4][5][6]. Interestingly the patient's first echocardiogram in 2002 was reported as an unusually significant LV outflow gradient given the minimal degree of LV hypertrophy.…”

“…Background: Trileaflet mitral valves were first described as recently as 2010 by Irwin et al [2]. Of these cases half describe an association with hypertrophic cardiomyopathy(HCM) [2][3][4][5][6]. Of these cases half describe an association with hypertrophic cardiomyopathy(HCM) [2][3][4][5][6].…”