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      Accessory mitral valve tissue: report of two asymptomatic cases.

      Radiology
      Adult, Aortic Stenosis, Subvalvular, etiology, Aortic Valve Insufficiency, Echocardiography, Female, Humans, Male, Mitral Valve, abnormalities, ultrasonography, Mitral Valve Insufficiency, complications, Mitral Valve Stenosis, Ventricular Outflow Obstruction

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          Abstract

          Accessory mitral valve tissue is a rare anomaly of embryologic development of the endocardial cushion and may cause substantial and progressive obstruction of the left ventricular outflow tract. Subaortic obstruction resulting from accessory mitral tissue is most likely due to systolic ballooning of the tissue into the outflow tract. The obstruction can occur in the early period of life as a result of mass effect or it can develop gradually due to the continued deposition of fibrous tissues within the left ventricular outflow tract. In patients with accessory mitral valve tissue, surgery is mandatory if there is a significant obstruction in the left ventricular outflow tract. We report two cases with accessory mitral valve tissue causing mild subaortic stenoses which did not require surgery. Copyright (c) 2006 S. Karger AG, Basel.

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          Accessory mitral valve tissue causing severe subaortic stenosis with dextrocardia in a premature newborn.

          We report an unusual case of left-ventricular outflow obstruction caused by accessory mitral valve tissue associated with dextrocardia and ventricular septal defect in a seven-day-old, 2200 grams premature infant, who was referred with a heart murmur. The diagnosis was made by two-dimensional and Doppler echocardiography which demonstrated the accessory tissue as well as a 100 mmHg peak systolic gradient between the left ventricle and the aorta. Ten days after the presentation the infant underwent emergency surgery after respiratory arrest and recurrent episodes of syncope. The accessory mitral valve tissue and its fibrous extension were excised and the ventricular septal defect was closed. We believe that surgical treatment of patients with accessory mitral valve tissue should be performed early because of the possibility of acute deterioration. Combined aortotomy and interatrial approach is very helpful in evaluating the anatomy and the mitral valve function as well as delineating the tissue to be excised.
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            Tetralogy of fallot with severe left ventricular outflow tract obstruction due to anomalous attachment of the mitral valve to the ventricular septum

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              Accessory mitral valve tissue causing left ventricular outflow obstruction (two-dimensional echocardiographic diagnosis and surgical approach).

              Accessory mitral valve tissue, a rare cause of left ventricular outflow tract obstruction, can be difficult to diagnose preoperatively and confusing even at surgery. The reported case illustrates how preoperative evaluation can be made using two-dimensional echocardiography combined with Doppler flow analysis. The intraoperative technique for removing the accessory tissue without causing damage to the native mitral valve is discussed.
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