Prolapsed mitral cusps in atrial septal defect. An erroneous radiological interpretation

Area of Science:

• Cardiology
• Cardiac Surgery
• Diagnostic Imaging

Background:

• Atrial septal defects (ASDs) are common congenital heart conditions.
• Mitral valve abnormalities can coexist with ASDs.
• Accurate diagnosis of mitral valve pathology is crucial for surgical planning.

Purpose of the Study:

• To evaluate the diagnostic accuracy of left ventriculography in identifying mitral valve prolapse and other abnormalities in patients with simple atrial septal defects.
• To compare angiographic findings with intraoperative surgical assessments.

Main Methods:

• Left ventriculography (cineangiography and/or still films) was performed on 40 patients with simple atrial septal defects.
• All patients underwent open heart surgery with direct mitral valve inspection by experienced surgeons.
• Angiographic diagnoses were compared with surgical findings.

Main Results:

• Angiography suggested mitral valve prolapse in 28 patients, but only 5 cases were confirmed during surgery.
• Five patients had other mitral valve abnormalities not always detected by angiography.
• Eighteen patients showed no signs of mitral valve dysfunction post-operatively.
• Left ventriculography demonstrated unreliability in diagnosing mitral valve abnormalities in secundum ASDs, except when the valve was structurally normal.

Conclusions:

• Left ventriculography frequently overdiagnoses mitral valve prolapse in the context of atrial septal defects.
• The diagnostic accuracy of left ventriculography for mitral valve abnormalities in ASD patients is limited.
• Surgical inspection remains the gold standard for assessing mitral valve integrity in these patients.