Unexpected Mitral Regurgitation During Coronary Artery Bypass Graft Surgery: The Multidisciplinary Management of a Mitral Valve Cleft.

AN ISOLATED CLEFT of a mitral valve leaflet is a rare finding in adult cardiovascular practice, with an estimated incidence of 0.1%. 1 Guerreiro C. Fonseca C. Ribeiro J. et al. Isolated cleft of the posterior mitral valve leaflet: The value of 3D TEE in the evaluation of mitral valve anatomy. Echocardiography. 2016; 33: 1265-1266 Crossref PubMed Scopus (7) Google Scholar , 2 Do H. Ito H. Jacobs W. A case of an isolated cleft in the posterior mitral leaflet. J Echocardiogr. 2009; 7: 84 Crossref PubMed Scopus (2) Google Scholar Although rare, a mitral cleft may be an important etiology for significant mitral regurgitation (MR). 1 Guerreiro C. Fonseca C. Ribeiro J. et al. Isolated cleft of the posterior mitral valve leaflet: The value of 3D TEE in the evaluation of mitral valve anatomy. Echocardiography. 2016; 33: 1265-1266 Crossref PubMed Scopus (7) Google Scholar , 2 Do H. Ito H. Jacobs W. A case of an isolated cleft in the posterior mitral leaflet. J Echocardiogr. 2009; 7: 84 Crossref PubMed Scopus (2) Google Scholar , 3 Townsley M.M. Chen E.P. Sniecinski R.M. Cleft posterior mitral valve leaflet: Identification using three-dimensional transesophageal echocardiography. Anesth Analg. 2010; 111: 1366-1368 Crossref PubMed Scopus (8) Google Scholar These clefts can pose a challenging diagnosis to the perioperative echocardiographer because they can be difficult to visualize despite comprehensive systematic mitral valve imaging with multiple views, especially in the setting of concomitant valvular lesions. 3 Townsley M.M. Chen E.P. Sniecinski R.M. Cleft posterior mitral valve leaflet: Identification using three-dimensional transesophageal echocardiography. Anesth Analg. 2010; 111: 1366-1368 Crossref PubMed Scopus (8) Google Scholar , 4 Amin A. Davis M. Auseon A. Isolated cleft posterior mitral valve leaflet: An uncommon cause of mitral regurgitation. Eur J Echocardiogr. 2009; 10: 173-174 Crossref PubMed Scopus (16) Google Scholar , 5 Manaladhze V. Capdeville M. Vivacqua A. Parachute-like asymmetric mitral valve associated with mitral valve cleft and atrial septal defect in an adult. J Cardiothorac Vasc Anesth. 2011; 25: 1106-1108 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar This case conference presents and discusses the management of a clinical scenario in which a mitral valve cleft was diagnosed intraoperatively in an adult patient who presented for coronary artery bypass grafting (CABG).