Parachute mitral valve assessed by cardiac magnetic resonance

Abstract

Parachute mitral valve (PMV) is a congenital cardiac malformation where typically all tendons chordae converge and insert into one major papillary muscle. We report the case of 27-year-old man affected by Hodgkin’s lymphoma-mixed cellularity subtype with polychemotherapy treatment and Barrett’s esophagus who came to our attention for routine echocardiographic exam and evaluation of left ventricular function. In the presence of normal left ventricular systolic function and mild-moderate mitral regurgitation, a careful examination of mitral apparatus showed a single papillary muscle suspected for PMV. In the presence of Barrett’s esophagus, the patient was further assessed cardiac magnetic resonance (CMR) that confirmed the diagnosis of PMV and excluded other associated congenital anomalies. Despite the rare incidence of PMV and a diagnosis generally based on transesophageal echocardiography, CMR could represent a useful tool, in selected cases, to confirm the diagnosis of PMV, identify other possible congenital anomalies, and assess ventricular and valvular function.

Beware Before Mitral Balloon Valvuloplasty: Parachute Mitral Valve Can Mimic Rheumatic Mitral Stenosis

“…1,2 A cardiac magnetic resonance imaging demonstrated the mitral valve chordae originated from the posteromedial papillary muscle (Figure 2A and 2B), a parachute mitral valve morphology variant. 3 A stress echocardiogram revealed no left ventricular (LV) ischemia but significantly worsened LV inflow obstruction (mean MV gradient increased from 6.5 to 25 mm Hg) and development of pulmonary hypertension with an increase in right ventricular systolic pressure from 30 mm Hg at rest to 60 mm Hg. Since MBV was relatively contraindicated due to high-risk anatomy, the patient was referred for surgery.…”

“…These deformities create a funnel configuration of the mitral valve that confers its parachute-like shape and LV inflow stenosis. [2][3][4] The PMV mimics an open parachute apparatus, as seen by multimodality imaging: the doming shape of the valve leaflets act as the parachute canopy, the chordae as the strings or suspension lines, and the papillary muscle as the risers and harness that attach to the rider. The combination of these abnormalities results in mitral inflow obstruction, which can mimic rheumatic MS.…”