Isolated Cleft of the Posterior Mitral Leaflet in 8 Year Old Patient

Abstract

First symptoms seemingly occured at the age of 5. Diagnosis of moderately severe mitral regurgitation was brought 2 years before the surgical treatment and our patient was on a regular cardiologic follow-up with prescribed ACE inhibitors and diuretics. Physical exam showed asthenic body type and systolic ejection click in the precordial projection of mitral valve. Preoperative echocardiography (Figure 1) showed enlargement of the left heart cavities, predominantly left atrium (dimensions 28x38x23 mm): Anulus of the mitral valve was cca 25 mm in diameter and the prolapse of the posterior leaflet was present. Significant mitral regurgitation with two regurgitational jets was noted. The first regurgitational jet sank along the interatrial septum IAS towards the entrance to pulmonary vein inflow tract, but without reverse flow in pulmonary veins. The second central jet reached 2/3 of the LA. According to the analysis of the first regurgitational jet, only moderately severe regurgitation could be described, but summation of the two mentioned jets directed us towards the diagnosis of severe MR.