Double orifice mitral valve – A case report

  • Ljilja B Musić Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
  • Božidarka Knežević Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
  • Ljiljana Jovović Institute for Cardiovascular Disease “Dedinje”, Belgrade, Serbia
  • Nebojša Bulatović Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
Keywords: heart defects, congenital, diagnosis, echocardiography, transesophageal,

Abstract


Introduction. Double orifice mitrol valve (DOMV) is a very rare congenital heart defect. Case report. We reported 20-year-old male referred to our center due to evaluation of his cardiologic status.  He was operated on shortly after birth for a tracheoesophageal fistula. Accidentally, echocardiography examination at the age of 4 years revealed double orifice mitral valve (DOMV) without the presence of mitral regurgitation, as well as mitral stenosis, with normal dimensions of all cardiac chambers. The patient was asymptomatic, even more he was a kick boxer. His physical finding was normal. Electrocardiography showed regular sinus rhythm, incomplete right bundle branch block. Transthoracic echocardiography (TTE) examination revealed the normal size of the left atrial, mitral leaflets were slightly more redundant. The left and right heart chambers, aorta, tricuspid valve and pulmonary artery valve were normal. During TTE examination on a short axis view two asymmetric mitral orifices were seen as a double mitral orifice through which we registered normal flow, without regurgitation and mitral stenosis. Transesophageal echocardiography (TEE) examination from the transgastric view at the level of  mitral valve, showed 2 single asymmetric mitral orifices separated by fibrous tissue,  mitral leaflet with a separate insertion of hordes for each orifice. Conclusion. The presented patient with DOMV is the only one recognized in our country. The case is interesting because during 16-year a follow-up period there were no functional changes despite the fact that he performed very demanded sport activities. This is very important because there is no information in the literature about that.


Author Biography

Ljilja B Musić, Department of Cardiology, Clinical Center of Montenegro, Podgorica, Montenegro
Kardiologija, Poremećaji ritma srca, Ishemijska bolest, Hipertenzija , Prevencija KVB,

References

Greenfield WS. Double mitral valve. Trans Pathol Soc (London) 1876; 27: 128−9.

Anwar AM, McGhie JS, Meijboom FJ, Ten CF. Double orifice mi-tral valve by real-time three-dimensional echocardiography. Eur J Echocardiogr 2008; 9(5): 731−2.

Tandon R, Takkar S, Kumbhkarni S, Kumar N, Aslam N, Mohan B, et al. A rare case of double orifice mitral valve with perimembranous ventricular septal defect: Application of three-dimensional echocardiography for clinical decision mak-ing. Ann Pediatr Cardiol 2010; 3(1): 87−9.

Ozeke O, Ozbakir C, Gunel EN. Double Mitral Valve Imaging. J Am Soc Echocardiogr 2010; 23(3): 340.e1−2.

Trowitzsch E, Bano-Rodrigo A, Burger BM, Colan SD, Sanders SP. Two-dimensional echocardiographic findings in double orifice mitral valve. J Am Coll Cardiol 1985; 6(2): 383−7.

Baño-Rodrigo A, van Praagh S, Trowitzsch E, van Praagh R. Double-orifice mitral valve: A study of 27 postmortem cases with developmental, diagnostic and surgical considerations. Am J Cardiol 1988; 61(1): 152−60.

Hoffman P, Stümper O, Groundstroem K, Sutherland G. The transesophageal echocardiographic features of double-orifice left atrioventricular valve. J Am Soc Echocardiogr 1993; 6(1): 94−100.

Karas S, Barbetseas J, Lambrou S, Parissis J, Metzikof D, Toutouzas P. Well-functioning double-orifice mitral valve in a young adult. J Clin Ultrasound 2003; 31(3): 170−3.

Taksande A, Goutami V, Thomas E. Double orifice mitral valve associated with Ventricular Septal Defect in an infant: Case Report. Pediatric Cardiol 2011; 13(1): 6−9.

Zalzstein E, Hamilton R, Zucker N, Levitas A, Gross GJ. Presenta-tion, natural history, and outcome in children and adolescents with double orifice mitral valve. Am J Cardiol 2004; 93(8): 1067−9.

Yesilbursa D, Miller A, Nanda NC, Mukhtar O, Huang WY, An-singkar K, et al. Echocardiographic diagnosis of a stenotic dou-ble orifice parachute mitral valve with a single papillary muscle. Echocardiography 2000; 17(4): 349−52.

Sugiyama H, Hoshiai M, Toda T, Nakazawa S. Double-Orifice Mitral Valve Associated with Noncompaction of Left Ventric-ular Myocardium. Pediatr Cardiol 2006; 27(6): 746−9.

Shiran A, Lewis BS. Acquired partially flail leaflet causing severe mitral regurgitation in a congenital double-orifice mitral valve. J Am Soc Echocardiogr 2004; 17(5): 478−9.

Kim S, Shin E, Lee S. Congenital double-orifice mitral valve with mitral regurgitation due to flail leaflet in an elderly patient. Korean J Intern Med 2005; 20(3): 251−4.

Gerber IL, Calder LA, Ruygrok PN, Greaves SC, Gibbs HC, Long S, et al. Association of a double orifice mitral valve with a bi-cuspid aortic valve in an explanted heart with dilated cardio-myopathy. Heart Lung Circ 2003; 12(3): 188.

Park IS, Yoo SJ, Kim KS, Hong CY. Tricuspid atresia associated with double-orifice mitral valve and coronary sinus septal de-fect. Tex Heart Inst J 1991; 18(3): 202−5.

Abdullah M, Pearce K, Palmer N, Chenzbraun A. Double orifice mitral valve with dysplastic tricuspid valve and intact interatrial septum: a three-dimensional echocardiographic study. Eur J Echocardiogr 2008; 9(4): 598−9.

Westendorp IC, de Bruin-Bon HA, Hrudova J. Double orifice mitral valve; a coincidental finding. Eur J Echocardiogr 2006; 7(6): 463−4.

Warnes C, Somerville J. Double mitral valve orifice in atrioven-tricular defects. Br Heart J 1983; 49(1): 59−64.

Lu Q, Lu X, Xie M, Wang X, Wang J, Yang Y, et al. Real-time three-dimensional echocardiography in assessment of congenital double orifice mitral valve. J Huazhong Univ Sci Technol Med Sci 2006; 26(5): 625−8.

McElhinney DB, Sherwood MC, Keane JF, del Nido PJ, Almond CS, Lock JE. Current management of severe congenital mitral ste-nosis: outcomes of transcatheter and surgical therapy in 108 infants and children. Circulation 2005; 112(5): 707−14.

Hartas GA, Rao PS, Balaguru D. Mitral Valve, Double Orifice. eMedicine from WebMD. Available from: http://emedicine.medscape.com/article/897322-overview. [updated 2014 October 05].

Kim MH, Cha KS, Kim JS, Hung JS, Lau KW. Successful inoue balloon mitral commissurotomy in double-orifice mitral steno-sis. Catheter Cardiovasc Interv 2000; 49(2): 200−3.

Published
2017/03/07
Section
Case report