Naeim Hesham A, Taha Elsayed A, Taha Reham A, Alatawi Faisal O, Amodi Osama, Abuelatta Reda
Madina Cardiac Centre, Saudi Arabia.
Al-Azhar university, Egypt.
J Cardiol Cases. 2019 Feb 24;19(6):177-181. doi: 10.1016/j.jccase.2019.01.005. eCollection 2019 Jun.
Reported cases of uni-leaflet mitral valve (MV) were related to the absence or dysplasia of the posterior mitral leaflet with ample anterior mitral leaflet. We present here a new entity of uni-leaflet MV where the MV appears as a membrane-like structure with a single slit-like orifice at its lateral part with no commissures.
Continuous Doppler flow revealed a mean pressure gradient of 19 mmHg across the mitral valve indicating severe mitral stenosis. In 3D images from the left atrial view, the MV appeared like a membrane with a single orifice in its lateral part toward the left atrial appendage, the area of this orifice by 3D was 0.52 cm, there were no commissures or even any residual lines at the site where commissures should be. The diagnosis of congenital severe mitral stenosis due to acommissural MV was confirmed. During surgery, the surgical appearance of the MV confirmed our diagnosis by 3D.
Isolated congenital severe mitral stenosis presenting in adulthood is rare, uni-leaflet MV as a cause is only reported in a few cases. MV replacement is usually indicated due to the abnormal anatomy of MV leaflets and the subvalvular apparatus.< How to diagnose uni-leaflet congenital mitral stenosis and how to differentiate it from other causes of congenital mitral stenosis.>.
已报道的单叶二尖瓣(MV)病例与后叶二尖瓣缺失或发育异常以及前叶二尖瓣宽大有关。我们在此呈现一种新型单叶MV,其MV表现为膜状结构,在其外侧部分有单个裂隙样开口,无瓣叶交界。
连续多普勒血流显示二尖瓣平均压力阶差为19 mmHg,提示重度二尖瓣狭窄。从左心房视图的三维图像中,MV看起来像一个膜,在其朝向左心耳的外侧部分有单个开口,该开口的三维面积为0.52平方厘米,在瓣叶交界应在的部位没有瓣叶交界,甚至没有任何残留痕迹。确诊为无交界性MV所致先天性重度二尖瓣狭窄。手术中,MV的手术外观通过三维成像证实了我们的诊断。
成年期出现的孤立性先天性重度二尖瓣狭窄很少见,单叶MV作为病因仅在少数病例中报道。由于MV瓣叶和瓣下结构解剖异常,通常需要进行二尖瓣置换。<如何诊断单叶先天性二尖瓣狭窄以及如何将其与先天性二尖瓣狭窄的其他病因相鉴别。>