Pseudo-double orifice mitral valve or heart in heart mitral valve

Pseudo-double orifice mitral valve or heart in heart mitral valve

Journal of Indian College of Cardiology 6 (2016) 84–85 Contents lists available at ScienceDirect Journal of Indian College of Cardiology journal hom...

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Journal of Indian College of Cardiology 6 (2016) 84–85

Contents lists available at ScienceDirect

Journal of Indian College of Cardiology journal homepage: www.elsevier.com/locate/jicc

Case Report

Pseudo-double orifice mitral valve or heart in heart mitral valve Panneerselvam Arunkumara,b,*, Thilagam Rajesha a b

K.R. Hospital, Periyanaiyakenpalayam, India Eugene Clinic, Mettupalayam, India

A R T I C L E I N F O

A B S T R A C T

Article history: Received 8 May 2016 Accepted 31 May 2016 Available online 6 July 2016

Pseudo-double orifice mitral valve is a condition characterised by double orifice appearance of mitral valve and it occurs as a result of acquired heart disease. This article describes echocardiographic appearance of this condition and helps in differentiating from double orifice mitral valve. ß 2016

Keywords: Valvular heart disease Echocardiography

1. Images in cardiology A 55-year-old female presented with class II dyspnea on exertion for 6 months. On examination, the precardium was hyperdynamic with systolic murmur. Her investigation revealed

significant iron deficiency anemia due to dysfunctional uterine bleeding. Echocardiographic study revealed thickened, beaded mitral valve leaflets with severe sub-mitral fusion. The parasternal short axis view showed double orifice mitral valve (Fig. 1) which in end diastolic frame gave a ‘‘Heart in Heart’’ appearance. The major point differentiating congenital double orifice mitral valve from other conditions is the presence of two distinct tensor apparatus attached to each mitral valve orifice. In this patient, there was a single thickened tensor apparatus attached to the mitral valve leaflets (Fig. 3). The presence of thickened, beaded posterior mitral

Fig. 1. Parasternal short axis view showing double orifice mitral valve.

* Corresponding author at: Department of Cardiology, K.R. Hospital, Periyanaiyakenpalayam, Coimbatore, India. Tel.: +91 9442121653; fax: +91 4254222351. E-mail address: [email protected] (A. Panneerselvam). http://dx.doi.org/10.1016/j.jicc.2016.05.001 1561-8811/ß 2016

Fig. 2. Parasternal short axis view in end diastolic frame giving ‘‘Heart in Heart’’ appearance.

A. Panneerselvam, R. Thilagam / Journal of Indian College of Cardiology 6 (2016) 84–85

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valve leaflet with decreased mobility identifies the rheumatic etiology of this pseudo-double orifice mitral valve. Since the patient is asymptomatic after correction of anemia and has negligible left ventricular in-flow obstruction, she is on regular follow-up. Conflicts of interest The authors have none to declare.

Fig. 3. Parasternal long axis view demonstrating single subvalvular apparatus attached to valve leaflets. This feature differentiates acquired from congenital double orifice mitral valve.