Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Nov 12;32(10):553–560. doi: 10.1002/clc.20608

Isolated Cleft in the Posterior Mitral Valve Leaflet: A Congenital Form of Mitral Regurgitation

Christophè A Wyss 1, Frank Enseleit 1,✉, Bernd van der Loo 1, Jürg Grünenfelder 2, Erwin N Oechslin 3, Rolf Jenni 1
PMCID: PMC6653238  PMID: 19911346

Abstract

Background

Isolated congenital cleft of the posterior leaflet of the mitral valve is a rare cause of mitral regurgitation (MR). This study describes the clinical, echocardiographic, and intraoperative findings as well as treatment options.

Methods

Adults with an isolated cleft of the posterior mitral valve leaflet diagnosed by transthoracic echocardiography were evaluated with respect to clinical, echocardiographic, preoperative and intraoperative findings, and different surgical strategies.

Results

The prevalence of isolated cleft of the posterior mitral valve leaflet in all patients examined was 0.11% (n = 22 out of 19 320 evaluated echocardiograms); male gender was predominant (73%). Dyspnea on exertion was present in almost all patients with at least moderate regurgitation. The predominant localization of the cleft was within segment P2 (59%), followed by a cleft between P1/P2 (18%). An isolated cleft in segment P3 or segment P1 occurred twice in each segment (n = 2; 9%) and between P2/P3 once (n = 1; 5%). Regurgitation was severe in 50% (n = 11), moderate in 9% (n = 2), mild in 27% (n = 6), and only trivial in 14% (n = 3) of the patients. Surgical treatment involved reconstruction with ring annuloplasty in 45% (n = 10) and replacement in 4.5% (n = 1). A total of 11 patients (50%) with mostly mild or trivial mitral regurgitation were treated medically only.

Conclusion

Two‐dimensional high‐resolution cross‐sectional echocardiography allows the distinct diagnosis of a clefted posterior leaflet, whereas clinical presentation, electrocardiogram, chest x‐ray, and angiography are failing to identify the correct etiology of MR in patients with isolated posterior leaflet cleft mitral valve (IPLCMV). Patients with moderate to severe MR were treated surgically with excellent outcome. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (824.0 KB).

References

  • 1. Di Segni E, Edwards JE. Cleft anterior leaflet of the mitral valve with intact septa. A study of 20 cases. Am J Cardiol 1983; 51(6): 919–926. [DOI] [PubMed] [Google Scholar]
  • 2. Tamura M, Menahem S, Brizard C. Clinical features and management of isolated cleft mitral valve in childhood. J Am Coll Cardiol 2000; 35(3): 764–770. [DOI] [PubMed] [Google Scholar]
  • 3. Amin A, Davis M, Auseon A. Isolated cleft posterior mitral valve leaflet: an uncommon cause of mitral regurgitation. Eur J Echocardiogr 2009; 10(1): 173–174. [DOI] [PubMed] [Google Scholar]
  • 4. Kuhne M, Balmelli N, Tobler D, Linka A. Isolated cleft of the posterior mitral valve leaflet. Int J Cardiol 2007; 122(2): e15. [DOI] [PubMed] [Google Scholar]
  • 5. Glover L, Baxley WA, Dodge HT. A quantitative evaluation of heart size measurements from chest roentgenograms. Circulation 1973; 47(6): 1289–1296. [DOI] [PubMed] [Google Scholar]
  • 6. Quere JP, Tribouilloy C, Enriquez‐Sarano M. Vena contracta width measurement: theoretic basis and usefulness in the assessment of valvular regurgitation severity. Curr Cardiol Rep 2003; 5(2): 110–115. [DOI] [PubMed] [Google Scholar]
  • 7. Roberts BJ, Grayburn PA. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations. J Am Soc Echocardiogr 2003; 16(9): 1002–1006. [DOI] [PubMed] [Google Scholar]
  • 8. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57(6): 450–458. [DOI] [PubMed] [Google Scholar]
  • 9. Ganau A, Devereux RB, Roman MJ, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19(7): 1550–1558. [DOI] [PubMed] [Google Scholar]
  • 10. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18(12): 1440–1463. [DOI] [PubMed] [Google Scholar]
  • 11. Davila JC, Palmer TE. The mitral valve. Anatomy and pathology for the surgeon. Arch Surg 1962; 84: 174–198. [DOI] [PubMed] [Google Scholar]
  • 12. Victor S, Nayak VM. Definition and function of commissures, slits and scallops of the mitral valve: analysis in 100 hearts. Asia Pacific J Thorac Cardiovasc Surg 1994; 3: 10–16. [Google Scholar]
  • 13. Venturini E, Ballestra AM. Posttraumatic pericardial laceration and cleft of the anterior mitral leaflet (in italian). G Ital Cardiol 1995; 25(8): 1037–1041. [PubMed] [Google Scholar]
  • 14. Perier P, Clausnizer B. Isolated cleft mitral valve: valve reconstruction techniques. Ann Thorac Surg 1995; 59(1): 56–59. [DOI] [PubMed] [Google Scholar]
  • 15. Craver JM, Cohen C, Weintraub WS. Case‐matched comparison of mitral valve replacement and repair. Ann Thorac Surg 1990; 49(6): 964–969. [DOI] [PubMed] [Google Scholar]
  • 16. Mihaileanu S, Marino JP, Chauvaud S, et al. Left ventricular outflow obstruction after mitral valve repair (Carpentier's technique). Proposed mechanisms of disease. Circulation 1988; 78(3 pt 2): I78–84. [PubMed] [Google Scholar]
  • 17. Pasic M, Von Segesser L, Niederhauser U, Vogt P, Jenni R, Turina M. Outflow tract obstruction after mitral valve repair without an annuloplasty ring. Eur J Cardiothorac Surg 1995; 9(5): 283–285. [DOI] [PubMed] [Google Scholar]
  • 18. Carpentier A. Cardiac valve surgery—the “French correction.” J Thorac Cardiovasc Surg 1983; 86(3): 323–337. [PubMed] [Google Scholar]
  • 19. Carpentier AF, Lessana A, Relland JY, et al. The “physio‐ring”: an advanced concept in mitral valve annuloplasty. Ann Thorac Surg 1995; 60(5): 1177–1185. [DOI] [PubMed] [Google Scholar]
  • 20. Carpentier A, Chauvaud S, Fabiani JN, et al. Reconstructive surgery of mitral valve incompetence: ten‐year appraisal. J Thorac Cardiovasc Surg 1980; 79(3): 338–348. [PubMed] [Google Scholar]
  • 21. Rusted IE, Scheifley CH, Edwards JE. Studies of the mitral valve. I. Anatomic features of the normal mitral valve and associated structures. Circulation 1952; 6(6): 825–831. [DOI] [PubMed] [Google Scholar]
  • 22. Duplessis LA, Marchand P. The anatomy of the mitral valve and its associated structures. Thorax 1964; 19: 221–227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Ranganathan N, Lam JH, Wigle ED, Silver MD. Morphology of the human mitral valve. II. The value leaflets. Circulation 1970; 41(3): 459–467. [DOI] [PubMed] [Google Scholar]
  • 24. Wilcox BR, Anderson RH. Surgical Anatomy of the Heart. London, UK: Gower Medical Publishing; 1991. [Google Scholar]
  • 25. Mumm B, Baumann R, Hyca M. Three‐dimensional echo for the assessment of valvular heart disease. Cardiol Clin 2007; 25(2) 283–295. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES