CASE PRESENTATİON
A 28-year-old female patient was admitted to the cardiology outpatient clinic with the complaint of shortness of breath for two years. Her medical history was not significant. Cardiac auscultation showed a 3/6 grade holosystolic murmur on the left sternal border. Her electrocardiogram (ECG) revealed no significant abnormalities. The transthoracic echocardiography (TTE) had revealed severe mitral regurgitation from the anterior leaflet, left atrial enlargement, mild tricuspid insufficiency, a normal systolic function (LVEF %60), an intact interatrial septum, and elevated systolic pulmonary artery pressure (33 mmHg). The transesophageal echocardiography (TEE) showed a cleft that was between the mitral valve A1 and A2 scallops, and severe regurgitation flow was detected from the cleft region and mild regurgaiton flow was detected from the coaptation line. Systolic inversion of pulmonary venous flow was also found. (Video 1, Video 2) The patient was evaluated by the heart team and underwent mitral valve repair with directed cleft suture. Postoperative TTE revealed very good results of mitral valve repair and a mild pericardial effusion. The patient was discharged.
A 19-year-old female was referred to our outpatient clinic with suspected congenital heart disease. At admission the patient was asymptomatic. Her medical history was not significant. Cardiac auscultation showed a 2/6 grade holosystolic murmur on the mitral area. Her ECG showed normal sinus rhythm. A previous TTE had revealed a moderate mitral regurgitation from the anterior leaflet, a conserved systolic function (LVEF %60), an intact interatrial septum, and normal systolic pulmonary artery pressure. The TEE revealed thickening of the mitral valve A2P2 and A3P3 scallops, a cleft between the A2A3 scallops and moderate-severe mitral regurgitation from the cleft and moderate mitral regurgation from the coaptation line. (regurgitant volume 36 mL/beat) (Video 3, 4) The follow-up of the asymptomatic patient continues.