Transesophageal Echocardiographic Evaluation of a Double Orifice Mitral Valve

Abstract

Intraoperative transesophageal echocardiography currently is used routinely for many cardiothoracic surgical procedures. Although it is often used for intraoperative cardiac monitoring and to confirm preoperative echocardiographic findings, it may sometimes result in the discovery of unexpected pathology. In this e-challenge, a patient was found to have a mitral valve abnormality that was not previously detected on the preoperative transthoracic echocardiogram. The mitral valve anomaly subsequently was evaluated to characterize the anatomy, interrogate the valve, and provide a diagnosis.

A Rare Case of Double Orifice Mitral Valve

“…Rarely reported in isolation, DOMV usually presents in early childhood or adolescence due to its association with other congenital heart defects such as coarctation of the aorta, patent ductus arteriosus and atrioventricular septal defects. [ 4 ] As evidenced in our patient, who had an associated ASD. However, he was asymptomatic in the early years of his life and presented at 50 years of age.…”

“…(C) Complete bridge type as exemplified by our case, where the complete ridge of tissue extends from the anterior to the posterior annulus with the separate orifices visible throughout the valvular ring. [ 4 ]…”

Complete and incomplete bridge type double‐orifice mitral valve: Diagnosis and characterization with three‐dimensional transesophageal echocardiography

“…3 3D-TEE is a valuable tool for characterizing and classifying this congenital cardiac lesion. 2,3 In our first patient, we see how on 2D-TEE the "fibrous strand" could be mistaken…”

“…Double orifice mitral valve (DOMV) is a rare congenital cardiac anomaly occurring in 1% of autopsied cases of congenital heart disease and is typically associated with other congenital cardiac pathologies 1 . DOMV is defined as a single fibrous annulus with two orifices opening into the left ventricle and can be classified into three types: the “incomplete bridge type” the “complete bridge type” as described for patients 1 and 2 in our case image series and the then the ‘hole type’ where a secondary orifice with subvalvular apparatus occurs in the lateral commissure of the MV 3 . 3D‐TEE is a valuable tool for characterizing and classifying this congenital cardiac lesion 2,3 .…”

Intraoperative Transesophageal Echocardiographic Detection of a Gerbode Defect in a Patient Referred for Aortic Valve Endocarditis: A Case Report

“…However, intraoperative TEE may uncover new pathologies that require an alternative surgical procedure, result in case cancellation, or may be left untreated. 2,3 In this report, we present a case in which the intraoperative TEE showed a new finding of a Gerbode defect, which ultimately altered the intended surgical procedure.…”