The PLV improves LV performance by a dramatic reduction of ventricular end-systolic and end-diastolic stresses. Further studies are needed to assess whether this effect is sustained during long-term follow-up and to define the role of PLV in the treatment of patients with dilated cardiomyopathy.
Cor triatriatum dexter is a rare congenital heart anomaly in which a membrane divides the right atrium into 2 chambers. We report the case of a 43-year-old C or triatriatum dexter (CTD) is a congenital anomaly in which the right atrium is divided into 2 parts by a membrane or fibromuscular band. This condition is extremely rare: in high-volume echocardiographic laboratories, the prevalence of CTD is less than 0.01%.1 Cor triatriatum dexter is often associated with other congenital anomalies, such as pulmonary artery stenosis or atresia, hypoplastic right ventricle, Ebstein anomaly, and atrial septal defect (ASD).2,3 Symptomatic patients with CTD and ASD are typically candidates for surgery, although successful percutaneous procedures have been reported. 4,5 We report our experience with a CTD patient when we attempted percutaneous treatment of the anomaly. Case ReportIn January 2013, a 43-year-old woman was examined at a regional hospital because of dyspnea on exertion (New York Heart Association [NYHA] functional class II-III). She had no signs of chronic heart failure. A continuous murmur was heard. A transthoracic echocardiogram (TTE) showed a 2.5 × 3.5-cm ASD (pulmonary-to-systemic flow ratio, 3:1) and a membrane that incompletely divided the right atrium into 2 chambers. Cor triatriatum dexter or a giant Eustachian valve was suspected, and the patient was referred to our institution.We used transesophageal echocardiography (TEE) and catheterization in an attempt to correct the anomaly percutaneously. The TEE showed that a membrane divided the right atrium into upper and lower chambers, thus conf irming a diagnosis of CTD (Fig. 1). Percutaneous balloon dilation disrupted the membrane and enlarged the communication between the chambers. This exposed the complete absence of an inferior rim on the patient's ASD: no tissue was available for anchoring an Amplatzer Septal Occluder (St. Jude Medical, Inc.; St. Paul, Minn). The risks of device malpositioning, device embolization, and residual shunting were high, so the patient was scheduled for surgery.Median sternotomy was performed and cardiopulmonary bypass was established. Access to the anomaly was gained through a right atriotomy. The large, fibrous congenital membrane, partially disrupted by the earlier percutaneous dilation, ran diagonally through the right atrium, reaching the interatrial septum on one end and the orifice of the inferior vena cava (IVC) on the other (Fig. 2A). A free margin and multiple small fenestrations enabled communication between the 2 atrial compartments. The ASD had a well-defined rim except in its inferior portion, where there was none. We resected the membrane, preserved its basal section for reconstructing the interatrial septum (Fig. 2B), and closed the residual ASD with use of a 3 × 2.5-cm pericardial
IntroductionA parachute mitral valve is defined as a unifocal attachment of mitral valve chordae tendineae independent of the number of papillary muscles. Data from the literature suggests that the valve can be distinguished on the basis of morphological features as either a parachute-like asymmetrical mitral valve or a true parachute mitral valve. A parachute-like asymmetrical mitral valve has two papillary muscles; one is elongated and located higher in the left ventricle. A true parachute mitral valve has a single papillary muscle that receives all chordae, as was present in our patient. Patients with parachute mitral valves during childhood have multilevel left-side heart obstructions, with poor outcomes without operative treatment. The finding of a parachute mitral valve in an adult patient is extremely rare, especially as an isolated lesion. In adults, the unifocal attachment of the chordae results in a slightly restricted valve opening and, more frequently, valvular regurgitation.Case presentationA 40-year-old Caucasian female patient was admitted to a primary care physician due to her recent symptoms of heart palpitation and chest discomfort on effort. Transthoracic echocardiography showed chordae tendineae which were elongated and formed an unusual net shape penetrating into left ventricle cavity. The parasternal short axis view of her left ventricle showed a single papillary muscle positioned on one side in the posteromedial commissure receiving all chordae. Her mitral valve orifice was slightly eccentric and the chordae were converting into a single papillary muscle. Mitral regurgitation was present and it was graded as moderate to severe. Her left atrium was enlarged. There were no signs of mitral stenosis or a subvalvular ring. She did not have a bicuspid aortic valve or coarctation of the ascending aorta. The dimensions and systolic function of her left ventricle were normal. Our patient had a normal body habitus, without signs of heart failure. Her functional status was graded as class I according to the New York Heart Association grading.ConclusionsA recently published review found that, in the last several decades, there have been only nine adult patients with parachute mitral valve disease reported, of which five had the same morphological characteristics as our patient. This case presentation should encourage doctors, especially those involved in echocardiography, to contribute their own experience, knowledge and research in parachute mitral valve disease to enrich statistical and epidemiologic databases and aid clinicians in getting acquainted with this rare disease.
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