the art of defining cardiac morphology

Perforated Anterior Mitral Leaflet

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Perforated Mitral Valve

A 45 year old lady with Marfan’s syndrome and aortic root dilatation. Has had aortic valve replacement and noted to have MR post operatively. The leak was asymmetric. On 2D TEE, there was suspicion of perforation of the valve leaflet. Patient was referred for consideration of trans-catheter closure of perforated anterior leaflet of the Mitral valve. The 3D images obtained as part of the pre-intervention assessment is displayed above. The video shows the surgeons view of the mitral valve with aorta at 12 O'clock position and left atrial appendage at the 9O'clock position. The arrow points to the pacing wire inadvertently placed in the roof of the left atrium passing through the PFO. The arrows now point to the thickened and elevated ridges on the anterior mitral leaflet. There is dystrophic calcification on the AML at the hinge point to the aortic root. The subsequent three arrows shows the linear area of dehiscence of the anterior MV leaflet below the calcified ridges. The findings were confirmed at surgical replacement of the mitral valve

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