- Email: [email protected]
Parachute Mitral Valve
Accepted Manuscript Parachute Mitral Valve Nicola Vistarini, MD, MSc, Mustapha Belaidi, MD, Georges Desjardins, MD, Michel Pellerin, MD PII:
S0828-282X(15)01568-8
DOI:
10.1016/j.cjca.2015.10.025
Reference:
CJCA 1916
To appear in:
Canadian Journal of Cardiology
Received Date: 5 October 2015 Revised Date:
27 October 2015
Accepted Date: 28 October 2015
Please cite this article as: Vistarini N, Belaidi M, Desjardins G, Pellerin M, Parachute Mitral Valve, Canadian Journal of Cardiology (2015), doi: 10.1016/j.cjca.2015.10.025. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Vistarini
1
Parachute Mitral Valve
RI PT
Nicola Vistarini, MD, MSc,a,b Mustapha Belaidi, MD,c Georges Desjardins, MD,c Michel Pellerin, MDa
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal,
SC
a
Canada
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia University
School of Medicine, Italy c
M AN U
b
Department of Anesthesia, Montreal Heart Institute, Université de Montréal, Montreal,
TE D
Canada
Short title: Parachute mitral valve
AC C
EP
Word Count: 502
________________
Corresponding author: Michel Pellerin, MD, Department of Cardiac Surgery, Montreal Heart Institute, 5000 Bélanger St., Montreal, Quebec H1T 1C8 (Canada). Tel.: 514-3763330; Fax: 514-593-2157. E-mail: [email protected].
ACCEPTED MANUSCRIPT Vistarini
2
Summary A parachute mitral valve consists of a rare etiology of severe mitral stenosis in the adult population. We report a clinical case, outline the anatomical features, and optimal surgical
AC C
EP
TE D
M AN U
SC
RI PT
care principles.
ACCEPTED MANUSCRIPT Vistarini
3
A 52-year-old female consulted at the Montreal Heart Institute for severe dyspnea (NYHA Class III). She underwent a clinical investigation that demonstrated severe mitral valve stenosis. She did not recall any history of rheumatic fever in the past.
RI PT
A transoesophageal echocardiography (TEE) showed a true “parachute” mitral valve (Figure 1). A severe mitral stenosis (mean gradient 15.6 mmHg, valve area 0.85 cm2) was associated with unifocal insertion of the chordae tendinae to a single posteromedial papillary
SC
muscle, located higher in the left ventricle.
A minimally invasive endoscopic mechanical mitral valve replacement was performed
M AN U
through a 4cm right minithoracotomy and under femoro-femoral cardiopulmonary bypass. The resected surgical specimen confirmed the parachute shape of the mitral valve (Figure 2), as the chordae tendinae converged into a single enlarged and obstructive papillary muscle. She had a normal postoperative TEE. Her postoperative clinical evolution was uneventful and she was discharged home on postoperative day 5.
TE D
The “parachute” deformity of the mitral valve (PMV) represents a congenital form of mitral stenosis which is almost always associated with other cardiac or vascular anomalies.1-3 Isolated PMV is extremely rare, its diagnosis and surgical management in adulthood is not
EP
clearly established.4,5 In our opinion, the fibrosis and retraction of the leaflets combined to a thickened subvalvular apparatus in adulthood cases represent a contraindication to
AC C
reconstructive mitral surgery. When the valve replacement is performed the valve should be completely excised. The preservation of the subvalvular apparatus could indeed be associated to residual mitral stenosis or prosthetic mechanical valve malfunction due to leaflets entrapment.
Q:\Secrétariat Central\therfr\PUBL\Can J Cardiol\Parachute Mitral Valve_MP_ft\Parachute161015MPmarked.doc
ACCEPTED MANUSCRIPT Vistarini
4
References 1.
Remenyi B, Gentles TL.
Congenital mitral valve lesions:
Correlation between
morphology and imaging. Ann Pediatr Cardiol 2012;5:3-12. Tandon R, Moller JH, Edwards JE. Anomalies associated with the parachute mitral
RI PT
2.
valve: A pathologic analysis of 52 cases. Can J Cardiol 1986;2:278-81. 3.
Rosenquist GC. Congenital mitral valve disease associated with coarctation of the
SC
aorta: A spectrum that includes parachute deformity of the mitral valve. Circulation 1974;49:985-93.
Prado S, Levy M, Varco RL. Successful replacement of "parachute" mitral valve in a
M AN U
4.
child. Circulation 1965;32:130-3.
Erdogan O1, Aktoz M. Parachute mitral valve abnormality and bicuspid aortic valve
EP
TE D
in an asymptomatic adult patient. Can J Cardiol 2008;24:e57.
AC C
5.
ACCEPTED MANUSCRIPT Vistarini
5
Figure Legends
Figure 1. Transesophageal echocardiography showing a true parachute mitral valve, with
RI PT
unifocal insertion of the chordae tendinae to a single posteromedial papillary muscle (see arrows).
SC
Figure 2. “En bloc” resection of the parachute mitral valve showing a single papillary muscle
AC C
EP
TE D
M AN U
that receives all chordae tendinae.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S0828-282X(15)01568-8
DOI:
10.1016/j.cjca.2015.10.025
Reference:
CJCA 1916
To appear in:
Canadian Journal of Cardiology
Received Date: 5 October 2015 Revised Date:
27 October 2015
Accepted Date: 28 October 2015
Please cite this article as: Vistarini N, Belaidi M, Desjardins G, Pellerin M, Parachute Mitral Valve, Canadian Journal of Cardiology (2015), doi: 10.1016/j.cjca.2015.10.025. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Vistarini
1
Parachute Mitral Valve
RI PT
Nicola Vistarini, MD, MSc,a,b Mustapha Belaidi, MD,c Georges Desjardins, MD,c Michel Pellerin, MDa
Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal,
SC
a
Canada
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia University
School of Medicine, Italy c
M AN U
b
Department of Anesthesia, Montreal Heart Institute, Université de Montréal, Montreal,
TE D
Canada
Short title: Parachute mitral valve
AC C
EP
Word Count: 502
________________
Corresponding author: Michel Pellerin, MD, Department of Cardiac Surgery, Montreal Heart Institute, 5000 Bélanger St., Montreal, Quebec H1T 1C8 (Canada). Tel.: 514-3763330; Fax: 514-593-2157. E-mail: [email protected].
ACCEPTED MANUSCRIPT Vistarini
2
Summary A parachute mitral valve consists of a rare etiology of severe mitral stenosis in the adult population. We report a clinical case, outline the anatomical features, and optimal surgical
AC C
EP
TE D
M AN U
SC
RI PT
care principles.
ACCEPTED MANUSCRIPT Vistarini
3
A 52-year-old female consulted at the Montreal Heart Institute for severe dyspnea (NYHA Class III). She underwent a clinical investigation that demonstrated severe mitral valve stenosis. She did not recall any history of rheumatic fever in the past.
RI PT
A transoesophageal echocardiography (TEE) showed a true “parachute” mitral valve (Figure 1). A severe mitral stenosis (mean gradient 15.6 mmHg, valve area 0.85 cm2) was associated with unifocal insertion of the chordae tendinae to a single posteromedial papillary
SC
muscle, located higher in the left ventricle.
A minimally invasive endoscopic mechanical mitral valve replacement was performed
M AN U
through a 4cm right minithoracotomy and under femoro-femoral cardiopulmonary bypass. The resected surgical specimen confirmed the parachute shape of the mitral valve (Figure 2), as the chordae tendinae converged into a single enlarged and obstructive papillary muscle. She had a normal postoperative TEE. Her postoperative clinical evolution was uneventful and she was discharged home on postoperative day 5.
TE D
The “parachute” deformity of the mitral valve (PMV) represents a congenital form of mitral stenosis which is almost always associated with other cardiac or vascular anomalies.1-3 Isolated PMV is extremely rare, its diagnosis and surgical management in adulthood is not
EP
clearly established.4,5 In our opinion, the fibrosis and retraction of the leaflets combined to a thickened subvalvular apparatus in adulthood cases represent a contraindication to
AC C
reconstructive mitral surgery. When the valve replacement is performed the valve should be completely excised. The preservation of the subvalvular apparatus could indeed be associated to residual mitral stenosis or prosthetic mechanical valve malfunction due to leaflets entrapment.
Q:\Secrétariat Central\therfr\PUBL\Can J Cardiol\Parachute Mitral Valve_MP_ft\Parachute161015MPmarked.doc
ACCEPTED MANUSCRIPT Vistarini
4
References 1.
Remenyi B, Gentles TL.
Congenital mitral valve lesions:
Correlation between
morphology and imaging. Ann Pediatr Cardiol 2012;5:3-12. Tandon R, Moller JH, Edwards JE. Anomalies associated with the parachute mitral
RI PT
2.
valve: A pathologic analysis of 52 cases. Can J Cardiol 1986;2:278-81. 3.
Rosenquist GC. Congenital mitral valve disease associated with coarctation of the
SC
aorta: A spectrum that includes parachute deformity of the mitral valve. Circulation 1974;49:985-93.
Prado S, Levy M, Varco RL. Successful replacement of "parachute" mitral valve in a
M AN U
4.
child. Circulation 1965;32:130-3.
Erdogan O1, Aktoz M. Parachute mitral valve abnormality and bicuspid aortic valve
EP
TE D
in an asymptomatic adult patient. Can J Cardiol 2008;24:e57.
AC C
5.
ACCEPTED MANUSCRIPT Vistarini
5
Figure Legends
Figure 1. Transesophageal echocardiography showing a true parachute mitral valve, with
RI PT
unifocal insertion of the chordae tendinae to a single posteromedial papillary muscle (see arrows).
SC
Figure 2. “En bloc” resection of the parachute mitral valve showing a single papillary muscle
AC C
EP
TE D
M AN U
that receives all chordae tendinae.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT