Ann Thorac Surg 2001;72:1762
© 2001 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Left ventricular outflow tract obstruction due to mitral valve anomaly
Raffaele Calabrò, MDa,
Giuseppe Santoro, MD*a,
Carlo Pisacane, MDa,
Maria Giovanna Russo, MDa,
Giuseppe Pacileo, MDa,
Giuseppe Caianiello, MDa,
Yves LeCompte, MDb
a Pediatric Cardiology and Cardiac Surgery, A.O. "Monaldi", II University of Naples, Naples, Italy
b Unite Medico-Chirurgicale de Cardiologie Pediatrique, Institut Cardiovasculaire Paris Sud, Paris, France
* Address reprint requests to Dr Santoro, Ospedale V. Monaldi, Facoltà di Medicina e Chirurgia, Servizio di Cardiologia Pediatrica, Via Vito Lembo, 14, 84131 Salerno, Italy
e-mail: santoropino{at}tin.it
A 14-year-old patient was referred to our center due to dyspnea and syncope from moderate effort. At clinical examination a systodiastolic murmur at the midsternal level was recorded. A chest roentgenogram showed mild cardiac enlargement and normal pulmonary markings. An electrocardiogram showed left ventricular (LV) hypertrophy. At echocardiography a severe LV outflow tract obstruction (Doppler peak pressure gradient of 100 mm Hg), associated with both aortic and mitral valve regurgitation, was imaged. Left ventricular outflow tract obstruction was due to a "windsock-like" accessory mitral valve tissue that expanded during LV ejection period (Fig 1). At operation, this anomalous tissue, rising from the top of the posteromedial papillary muscle and extending just beneath the aortic valve (Fig 2), was carefully excised, thereby relieving the LV obstruction.
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Fig 1. Echocardiographic long axis view of the left ventricle (LV) showing the accessory mitral valve tissue arising from the top of the posteromedial papillary muscle (arrow) and crossing the LV outflow tract to attach just beneath the aortic valve. (Ao = aorta; LA = left atrium.)
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Fig 2. (A, B) Surgical view of the left ventricular outflow tract through the aortic cusps (asterisks) showing the accessory mitral valve tissue (cross) arising from the top of the posteromedial papillary muscle (arrows). (C) Surgical resection of the muscular stalk (arrow) of the accessory mitral valve tissue (cross).
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Acknowledgments
This work was supported by the Programma Operativo del Piano CCCN-5 B006 of the Ministero dell’Università e Ricerca Scientifica (MURST) and the European Community (711/1998).
Footnotes
A videoclip of this procedure can be viewed on the Internet at http://www.sts.org/section/atsvideo.
