J Cardiovasc Ultrasound.  2014 Mar;22(1):43-45. 10.4250/jcu.2014.22.1.43.

Unique Congenital Malformation of the Mitral Valve Associated with Anomalous Coronary Arteries and Stroke

• Elhussein
• Hutchison
• Said N

• KMID: 2177457
• DOI: http://doi.org/10.4250/jcu.2014.22.1.43

Abstract

A 55-year-old male presented with stroke. Transesophageal echocardiogram and cardiac computed tomography revealed an unrecognized congenital malformation of the anterior mitral leaflet associated with anomalous left coronary circumflex artery, arising from the right coronary artery, diagnosed first by echocardiogram. This case represents a unique unforeseen mitral valve anomaly that might be considered as potential cardiac source of embolism. This finding broadens the spectrum of known mitral valve anomalies.

Keyword

Mitral valve; Mitral valve prolapse; Anomalous coronary arteries; Transoesophageal echocardiography; Cardiac imaging; Congenital heart defects

MeSH Terms

Arteries
Coronary Vessels*
Embolism
Heart Defects, Congenital
Humans
Male
Middle Aged
Mitral Valve Prolapse
Mitral Valve*
Stroke*

Figure

• 

  Fig. 1 Transesophageal echocardiogram. Midesophageal long-axis view. The abnormal accessory tissue attached to the basal portion of the anterior mitral leaflet (arrow A). Origin of the left coronary artery (note the abnormal low origin in the sinus of Valsalva) (arrow B). Origin of the right coronary artery, note the larger vessel caliber (arrow C). Ao: aorta, LA: left atrium, LV: left ventricle, RV: right ventricle.

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  Fig. 2 Transesophageal echocardiogram. Midesophageal 4-chamber view at 0 degrees. The course of the left circumflex coronary artery (arrow A). The abnormal accessory tissue attached to the basal portion of the anterior mitral leaflet (arrow B). LV: left ventricle, RA: right atrium, RV: right ventricle.

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  Fig. 3 Transesophageal echocardiogram. Midesophageal 4-chamber view at 40 degrees with colour Doppler. A: In systole, there as a mild eccentric mitral regurgitation jet (arrow). B: In diastole, small jet of flow acceleration at the site of the accessory mitral tissue (arrow).

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  Fig. 4 Cardiac computed tomography angiogram. The abnormal accessory tissue attached to the basal portion of the anterior mitral leaflet (arrow). LA: left atrium, LV: left ventricle.

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  Fig. 5 Coronary computed tomography angiogram. Right coronary sinus of Valsalva (arrow). Right coronary artery (a). The anomalous left circumflex artery arising from the proximal right coronary artery, common ostium, with a retro-aortic course (b). Left anterior descending artery (c).

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