Acute Multiple Cerebral Infarction in a Patient with an Accessory Mitral Valve

Area of Science:

• Cardiology
• Neurology
• Cardiac Surgery

Background:

• Cerebral infarctions, or strokes, can have various etiologies, including embolic events.
• Cardiac abnormalities are a known source of emboli causing ischemic strokes.
• Accessory mitral valves are rare congenital anomalies.

Observation:

• A 96-year-old female presented with hemiparesis two weeks post-orthopedic surgery.
• Magnetic resonance imaging (MRI) revealed multiple bilateral cerebral infarctions.
• Transthoracic echocardiography identified a mobile structure on the anterior mitral leaflet, protruding into the left ventricular outflow tract.

Findings:

• The observed cardiac structure was diagnosed as an accessory mitral valve.
• Doppler echocardiography confirmed no significant left ventricular outflow tract obstruction.
• This case represents a rare instance of a clinically silent accessory mitral valve leading to embolic cerebral infarctions.

Implications:

• This case underscores the importance of cardiac evaluation in patients presenting with unexplained cerebral infarctions, particularly the elderly.
• Silent accessory mitral valves should be considered in the differential diagnosis of embolic stroke.
• Further research into the embolic potential of accessory mitral valves may be warranted.