Anomalies of the Mitral Valve

1. Calcified myxomatous degeneration of the mitral valve mimicking double orifice mitral valve

The Transoesophageal 2D image above is suggestive of a double orifice mitral valve. It gives the impression of central a raphae dividing the mitral valve into a small medial one and a larger lateral component. Both components appear to be coapting well. A small echogenic shadow is seen jutting into to the LA suggestive of a ruptured cord.

The 3D TOE video displayed above clearly demonstrates the pathology. There is severe calcification of the mitral valve forming a transverse ridge in the middle of the annulus giving the false impression of a divided mitral orifice. However, the morphology of the anteriro and posterior leaflets are maintained with clear demarkation of P1, P2 and P3 components of the PML. Note the rupured cords supporting P2 with it prolapsing into the LA causing severe MR. The 3D findings were confirmed at surgery.

 

MPR: Multiplanar Reformating demonstrating the anatomic details

Pannel A: (Cut through the anterio-posterior plane) shows the anterior aorta followed by the calcified anterior ridge, AML, central orifice of the mitral valve, ruptured P2 cordi, PML and calcified posterior ridge. Pannel B: (A cut at right angle to the anterio-posterior plane) shows the calcified anterior ridge giving the impression of double orifice mitral valve. Pannel C demonstrates the orthogonal planes corresponding to the 3D image in Pannel D