Congenital Mitral Valve Diseases

Abstract

A 66-year-old woman has a history of coronary artery bypass grafting in 1987, when she had left main stenosis and underwent bypass with anastomosis of the left internal mammary artery to the left anterior descending artery and a saphenous vein graft to the obtuse marginal branch. The patient now returns with symptoms of congestive heart failure. She is found to have an atrioventricular canal defect including mitral valve regurgitation with mitral valve cleft, primum atrial septal defect, and severe tricuspid regurgitation. She also has a left-sided superior vena cava, into which she has an anomalous left upper pulmonary vein. She has recently noticed a signifi cant decline and can now walk only half a block at a slow pace before having to stop. She was referred to our institute for surgical correction of her complex congenital heart disease (Figs. 9.1 , 9.2 , 9.3 , 9.4 , 9.5 , 9.6 , 9.7 , 9.8 , 9.9 , and 9.10 ). ing showed atrial septal defect with left-to-right shunt at the level close to the cardiac crux, consistent with primum atrial septal defect. Also seen are mitral and tricuspid regurgitation (AVI 2320 kb) Video 9.8 Transesophageal echocardiography (TEE) fourchamber view showed primum atrial septal defect (AVI 6583 kb) Video 9.9 TEE short axis view at aortic valve level showed bicuspid aortic valve (AVI 6459 kb) Video 9.10 3D TEE of mitral valve (surgical view) showed anterior mitral valve cleft (AVI 218 kb)