Original article
The Added Value of Real-time 3-Dimensional Echocardiography in the Diagnosis of Isolated Cleft Mitral Valve in Adults

https://doi.org/10.1016/j.echo.2005.12.024Get rights and content

We evaluated the potential advantage of real-time 3-dimensional echocardiography on the assessment of mitral valve morphology and function in patients with isolated cleft mitral valve. Five patients, aged 33 ± 9 years, with isolated cleft mitral valve and no associated cardiac anomalies, were studied. Real-time 3-dimensional echocardiography demonstrated the cleft in each case and allowed the measurement of its width and depth, the extent of cleft edge fibrosis and retraction, and the presence of accessory chordae and their attachment to the septum. Four patients had moderate or severe mitral regurgitation and in one patient the regurgitation was mild. In all patients the mitral regurgitant jet originating from the cleft was detected, and in one patient, a second jet was detected and not seen in the 2-dimensional study. Real-time 3-dimensional echocardiography is a reliable and reproducible technique that provides accurate and detailed echocardiographic characterization of the isolated cleft mitral valve in adults.

Section snippets

Methods

Our database included more than 45,000 echocardiographic examinations performed in adults between 1996 and 2004. Five patients (2 men, 3 women), with a mean age of 33 ± 9 years and with no previous surgical interventions, were diagnosed with isolated cleft mitral valve without associated heart disease.

All 5 patients were re-evaluated and detailed 2D and RT3D echocardiography was performed. Two-dimensional echocardiograms were performed using commercially available devices (Vivid 7, GE, Horten,

Results

On 2D echocardiography, diagnosis and measurement of the cleft width required careful and repeated analysis of the short-axis parasternal view at multiple valve levels. This technique revealed leaflet thickening; however, characterization of the full extent of fibrosis and retraction was not achieved. Accessory chordae were identified in 4 patients: one chorda was seen at its attachment to the septum and was characterized as being of chordal type, whereas the remaining chordae were visible but

Discussion

The anatomic aspects of cleft mitral valve without septal defects have been previously reviewed. 1, 5 The cleft usually involves the anterior leaflet, points toward the LVOT, and divides the leaflet into two portions. Anomalous chordal attachments to the septum or to the anterior wall, sometimes leading to subaortic obstruction, are a frequent finding. Mitral leaflets are smooth in younger patients, whereas cleft edge fibrosis increases with age. 1 Two-dimensional echocardiography facilitates

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