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Published on: May 19, 2020
[Congenital mitral valve anomalies in adults. Clinical and echocardiographic study]
Nilda Espinola-Zabaleta1, Mirna Yabur-Espitia
1Instituto Nacional de Cardiología Ignacio Chávez.
Insights
Congenital anomalies of the mitral valve (CAMV) are rare in adults but require precise diagnosis. Echocardiography is crucial for identifying these complex heart conditions and guiding timely, effective treatment strategies.
Area of Science:
- Cardiology
- Medical Imaging
- Congenital Heart Disease
Background:
- Congenital anomalies of the mitral valve (CAMV) encompass diverse leaflet and subvalvular apparatus malformations.
- CAMV presentation in adult populations is infrequent, posing diagnostic challenges.
Observation:
- This study evaluated five adult patients diagnosed with various forms of CAMV.
- Clinical assessment included history, electrocardiogram, chest X-rays, and echocardiography.
Findings:
- Diagnoses varied, including mitral valve prolapse with failure, parachute mitral valve, tri-leaflet mitral valve, double mitral orifice, and tunnel-forming mitral valve.
- Associated conditions included aortic abnormalities, patent ductus arteriosus, and pulmonary hypertension.
- Treatment involved valve replacement, aortic coarctation dilation, sitaxsentan therapy, and surgical planning.
Implications:
- Echocardiography is vital for accurately evaluating mitral valve and subvalvular apparatus anomalies in adults.
- Early and precise diagnosis through echocardiography facilitates appropriate treatment planning for CAMV patients.
Introduction:
Congenital anomalies of the mitral valve (CAMV) comprise a wide range of leaflet anomalies and of the subvalvular apparatus. Its presentation in adults is not frequent.
Objective:
In this work, we assessed the clinical and echocardiographic aspects as well as the treatment of five adult patients with CAMV.
Methods:
A complete clinical history was made for each patient. All patients were subjected to an electrocardiogram, Chest X-rays, and an echocardiogram.
Results:
Two patients were in functional class (FC) I, one in FC II, and two in FC III of the New York Heart Association. Diagnoses were: 1) prolapsed mitral valve with severe mitral failure, 2) parachute mitral valve associated with a subvalvular aortic fibrous ring and patent ductus arteriosus, 3) tri-leaflet mitral valve with subaortic obstruction, 4) double mitral orifice associated with bicuspid aorta and aortic coarctation, and 5) tunnel-forming mitral valve associated with ostium primum interatrial communication and pulmonary arterial hypertension and pulmonary artery hypertension. One patient was subjected to mitral valve change, one to dilation of the aortic coarctation, and another is under sitaxentan treatment, with improvement in the FC. The two remaining patients are awaiting surgery.
Conclusions:
Review of these cases with CAMV reveals the relevance of the echocardiogram in the evaluation of the mitral valve and of the subvalvular apparatus, because it allows for the identification of different types of malformations and their hemodynamic repercussion, to be able to propose the precise and timely treatment for these patients.
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