Successful Surgical Repair of the Parachute Mitral Valve with Mitral Valve Regurgitation

Abstract

A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.Keywords: parachute mitral valve, single papillary muscle, mitral valve regurgitation, mitral valve plasty Case ReportA 65-year-old woman who had exercise-related dyspnea was admitted to our hospital for evaluation. She had been asymptomatic before presentation. On physical examination, there was a grade 4/6 holosystolic regurgitant murmur audible throughout the precordium. The peripheral pulses were normal, and the rest of her examination was unremarkable. Anteroposterior chest X-ray demonstrated no cardiomegaly showed a sinus rhythm with a rate of 66/min, and complete right bundle branch block. A two-dimensional and color Doppler echocardiogram was performed. It demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle with a dilated left atrium and left ventricle, and a cleft in the posterior leaflet of the mitral valve (Fig. 1a). Color Doppler showed severe mitral valve regurgitation in systole (Fig. 1b). Pulse-Doppler recording of transmitral flow from the left ventricle apex demonstrated no features of mitral valve stenosis (Fig. 1c). Cardiac catheterization was performed which confirmed the diagnosis and demonstrated hyperkinetic pulmonary artery

Spectrum of congenital mitral valve abnormalities associated with solitary undifferentiated papillary muscle in adults

“…Repair is feasible in case there is predominant regurgitation with well-developed chords. Recently, repair in one of such cases has been reported 14 . It is prudent to follow Carpentier's approach in all such cases 8 …”

“…A series of six such cases presenting as mitral regurgitation and confirmed on surgery have been recently reported 4 . Despite two series of ten and six cases,4, 5 sketchy information is available about PMV or undifferentiated PM with mitral valve dysplasia in adults as an isolated anomaly or in association with other congenital cardiac anomalies 12, 13, 14, 15, 16, 17, 18. The clinical course of isolated PMV is varied depending on the presence and severity of mitral stenosis and regurgitation.…”