Cor Vasa 2017, 59(5):e441-e445

Accessory mitral valve tissue in association with bicuspid aortic valve and aortic coarctation

Tomáš Toporcer, Adrián Kolesár^*, Martin Ledecký, František Sabol

Klinika srdcovej chirurgie, Lekárska fakulta Univerzity Pavla Jozefa Šafárika a Východoslovenský ústav srdcových a cievnych chorôb a.s., Košice, Slovensko

Accessory mitral valve tissue (AMVT) is a rare congenital malformation of the heart. The first case of AMVT was described in 1842. The first surgical treatment of this lesion was published in 1963 and the first echocardiography diagnosis of AMVT was performed in 1985.
A 50-year-old male with medical history of surgery of aortic coarctation 39 years ago was accepted to the hospital because of dyspnoea and repeated pain in the left thorax. Echocardiography revealed bicuspid aortic valve including progressive dilatation of an aortic root and ascending aorta with mild aortic regurgitation. Dilatation of mitral annulus with moderate regurgitation (without stenosis) and accessory mitral valve tissue combined with trivial obstruction of left ventricle outflow tract (LVOT) was also present. AMVT with chordae was excised and mitral annuloplasty has been accomplished. Aortic root remodelling (Yacoub procedure) combined with an aortic valve repair and extra-aortic ring implantation has been performed subsequently. Control echocardiography one year following surgery showed no regurgitation on either aortic or mitral valve.
Symptomatology of the patient depends on the presence of AMVT associated with LVOT obstruction, moderate affection of aortic and mitral valves and on concomitant cardiovascular malformations. Echocardiography plays a principal role in the diagnosis, follow-up and indication of surgery of patients with this congenital lesion. Clinically silent AMVT requires follow-up, but it is not an indication for surgery itself. On the other hand AMVT associated with LVOT obstruction or mitral stenosis is an indication for surgery, especially combined with other cardiac malformations.

Keywords: Accessory mitral valve tissue; Congenital malformation; Left ventricle outflow tract obstruction

Received: July 3, 2016; Revised: October 10, 2016; Accepted: October 13, 2016; Published: October 1, 2017  Show citation