Mitral valve cleft associated with secundum atrial septal defect: case report and review of the literature.

Mitral valve cleft associated with secundum atrial septal defect (ASD) is uncommon. We report a 39-year-old male patient manifesting symptoms of congestive heart failure 3 months before admission. Echocardiography showed typical mitral valve prolapse and a large ASD of the secundum type. He was diagnosed as severe mitral regurgitation and ASD. At operation, severe mitral valve prolapse with additional degenerative leaflets and a middle-sized cleft in the anterior leaflet were noted. A large ASD of a mixed central and inferior vena cava type was found. Mitral valve repair was impossible. The mitral valve was replaced with an ATS prosthesis. The ASD was repaired with a pericardial patch. Three slow arrhythmias, including nodal rhythm, sinus bradycardia and atrial fibrillation, complicated his early postoperative course. The literature of this entity was reviewed, and the etiology of the postoperative slow arrhythmias was discussed.