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Case Report
Mubashir Hamid Bahrami
Indiana University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5734-6876
License:
This work is licensed under a CC BY 4.0 License. Read Full License
We report a unique presentation of isolated congenital cleft mitral valve complicating cardiogenic shock from acute myocardial infarction. Isolated cleft mitral valve is an uncommon diagnosis that can have significant clinical implications, especially if not recognized in patients presenting to the catheterization lab with acute myocardial infarction and cardiogenic shock. A review of this rare diagnosis including the options and timing of therapeutic interventions, which can include MitraClip, is important for publication.
The case is of a patient who presented with an anterior acute ST elevation myocardial infarction. Despite early coronary revascularization and conventional support, refractory cardiogenic shock ensued requiring mechanical circulatory support escalation to Veno-arterial extracorporeal membrane oxygenation. Subsequently, left ventriculography revealed a massively dilated left atrium and severe mitral regurgitation raising concerns for a mechanical mitral valve complication. The patient was taken to the operating room for possible mitral valve surgery, but a preoperative transesophageal echocardiogram revealed an isolated posterior cleft mitral valve. Since the patient had stabilized on mechanical circulatory support, emergent surgery was deferred. The patient successfully recovered during index hospitalization with mechanical circulatory support and discharged on guideline directed medical therapy.
In conclusion, isolated cleft mitral valve is a rare diagnosis that can often be underrecognized without comprehensive 3-dimensional transesophageal echocardiography evaluation. If diagnosed early with significant regurgitation, surgical treatment results in good outcomes and preservation of LV systolic function. Percutaneous correction of a CMVL with MitraClip has been described and may offer an alternative approach for high risk surgical patients.
Keywords
Cleft mitral valve, Congenital heart disease, Mitral regurgitation, MitraClip, Cardiogenic shock, Acute myocardial infarction, Mechanical circulatory support, Transesophageal echocardiography
Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- CoronaryAngiographyPostintervention.mov
Acute occlusion of the ostial LAD is seen on coronary angiography with TIMI 0 flow.
- CoronaryAngiographyPostintervention.mov
Acute occlusion of the ostial LAD is seen on coronary angiography with TIMI 0 flow.
- Coronaryangiography.mov
PCI was successfully performed with restoration of TIMI 3 flow.
- Coronaryangiography.mov
PCI was successfully performed with restoration of TIMI 3 flow.
- IntraoperativeTEE2DMitralregurgitation.mov
3-D TEE of the mitral valve revealed isolated posterior CMVL.
- IntraoperativeTEE2DMitralregurgitation.mov
3-D TEE of the mitral valve revealed isolated posterior CMVL.
- IntraoperativeTEE.mov
2-D TEE revealed significant mitral regurgitation.
- IntraoperativeTEE.mov
2-D TEE revealed significant mitral regurgitation.
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CURRENT STATUS: Under Review
Version 1
Posted 09 Dec, 2020
No community comments so far
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Review #1 received
Received 10 Dec, 2020
First submitted
On 02 Dec, 2020
Editor assigned
On 02 Dec, 2020
Submission checks complete
On 02 Dec, 2020
Editor invited
On 02 Dec, 2020
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Subject Areas
Cardiac & Cardiovascular Systems
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A new preprint design is coming!
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This preprint is under consideration at Journal of Congenital Cardiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Case Report
Mubashir Hamid Bahrami
Indiana University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5734-6876
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 09 Dec, 2020
No community comments so far
Reviewers invited
Invitations sent on 10 Dec, 2020
Reviewer #1 agreed
On 10 Dec, 2020
Review #1 received
Received 10 Dec, 2020
First submitted
On 02 Dec, 2020
Editor assigned
On 02 Dec, 2020
Submission checks complete
On 02 Dec, 2020
Editor invited
On 02 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
We report a unique presentation of isolated congenital cleft mitral valve complicating cardiogenic shock from acute myocardial infarction. Isolated cleft mitral valve is an uncommon diagnosis that can have significant clinical implications, especially if not recognized in patients presenting to the catheterization lab with acute myocardial infarction and cardiogenic shock. A review of this rare diagnosis including the options and timing of therapeutic interventions, which can include MitraClip, is important for publication.
The case is of a patient who presented with an anterior acute ST elevation myocardial infarction. Despite early coronary revascularization and conventional support, refractory cardiogenic shock ensued requiring mechanical circulatory support escalation to Veno-arterial extracorporeal membrane oxygenation. Subsequently, left ventriculography revealed a massively dilated left atrium and severe mitral regurgitation raising concerns for a mechanical mitral valve complication. The patient was taken to the operating room for possible mitral valve surgery, but a preoperative transesophageal echocardiogram revealed an isolated posterior cleft mitral valve. Since the patient had stabilized on mechanical circulatory support, emergent surgery was deferred. The patient successfully recovered during index hospitalization with mechanical circulatory support and discharged on guideline directed medical therapy.
In conclusion, isolated cleft mitral valve is a rare diagnosis that can often be underrecognized without comprehensive 3-dimensional transesophageal echocardiography evaluation. If diagnosed early with significant regurgitation, surgical treatment results in good outcomes and preservation of LV systolic function. Percutaneous correction of a CMVL with MitraClip has been described and may offer an alternative approach for high risk surgical patients.
Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- CoronaryAngiographyPostintervention.mov
Acute occlusion of the ostial LAD is seen on coronary angiography with TIMI 0 flow.
- CoronaryAngiographyPostintervention.mov
Acute occlusion of the ostial LAD is seen on coronary angiography with TIMI 0 flow.
- Coronaryangiography.mov
PCI was successfully performed with restoration of TIMI 3 flow.
- Coronaryangiography.mov
PCI was successfully performed with restoration of TIMI 3 flow.
- IntraoperativeTEE2DMitralregurgitation.mov
3-D TEE of the mitral valve revealed isolated posterior CMVL.
- IntraoperativeTEE2DMitralregurgitation.mov
3-D TEE of the mitral valve revealed isolated posterior CMVL.
- IntraoperativeTEE.mov
2-D TEE revealed significant mitral regurgitation.
- IntraoperativeTEE.mov
2-D TEE revealed significant mitral regurgitation.
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