Posterior mitral leaflet cleft in nonobstructive hypertrophic cardiomiopathy

A 43-year-old nigerian woman presented to cardiac intensive care unit for acute pulmonary edema with severe mitral regurgitation in a hypertrophic non obstructive cardiomyopathy for prevalent hypertrophy of posterior and lateral walls. A transesophageal echocardiography showed the isolated cleft of posterior mitral leaflet. In literature deep and multiple mitral valve clefts are described in patients with hypertrophic obstructive cardiomyopathy undergoing septal myectomy, including possible true posterior clefts, but they are not associated with the premyectomy severity of mitral regurgitation or jet direction, and do not result in surgical MV intervention. The hypertrophic cardiomyopathy is not confined to cardiac muscle but rather involves the mitral valve with structural abnormalities. In this case surgical correction of cleft was the solution for several mitral regurgitation.