An Extremely Rare Cause of Mitral Regurgitation—Accessory Commissural Mitral Tissue with Anomalous Left Atrial Chordal Attachment

Abstract

Graphical abstract

Anomalous left atrial chorda and its association with mitral regurgitation

“…Our patient presented with MR at an age of 27 years and did not have history of rheumatic heart disease or connective tissue disorder. Gurrieri et al , Vlassak et al , and Alghamdi et al [ 4 5 6 ] described presence of accessory chorda and MR in young patients; however, the proposed mechanism of MR was different in all the 3 patients. Mechanisms described for MR included the following: leaflet prolapse, leaflet tethering, cleft, perforation, and annular dilatation, which may escalate tethering.…”

“…Mechanisms described for MR included the following: leaflet prolapse, leaflet tethering, cleft, perforation, and annular dilatation, which may escalate tethering. In the case described by Gurrieri et al [ 4 ] the anomalous chorda originated from the posteromedial papillary muscle, coursed through the valve, attaching onto the LA wall, and impaired coaptation of leaflets, causing MR. Vlassak et al and Alghamdi et al [ 5 6 ] described the chordal attachment between interatrial septum and A2 causing MR. We believe that in our patient, the MR was secondary to tethering of the A2 and pulling it toward the LA roof resulting in prolapse of the A2. Additionally, in our patient, one primary chorda to the A2 was absent, perhaps, enhancing the pulling effect of accessory chorda.…”