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Year : 2018  |  Volume : 61  |  Issue : 3  |  Page : 450-451
A rare case of accessory mitral valve tissue


1 Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication13-Jul-2018
 

How to cite this article:
Vaiphei K, Kumar R, Bahl A. A rare case of accessory mitral valve tissue. Indian J Pathol Microbiol 2018;61:450-1

How to cite this URL:
Vaiphei K, Kumar R, Bahl A. A rare case of accessory mitral valve tissue. Indian J Pathol Microbiol [serial online] 2018 [cited 2019 Dec 8];61:450-1. Available from: http://www.ijpmonline.org/text.asp?2018/61/3/450/236606




A 49-years-old male, an uptopsy case, who wasen symptomatic for 15 –years, presented to the cardiology outpatient door with the history of breathlessness (New York Heart Association Class II) and palpitation on exertion with occasional nonanginal chest pain. He also complained of occasional episodes of syncope. Echocardiography revealed features of hypertrophic cardiomyopathy with interventricular septum thickening measuring 26 mm, left ventricular ejection fraction of 77%, and systolic anterior motion. He also had evidence of mild mitral regurgitation with left atrial size of 54 mm. During the course of the disease, he had worsening of symptoms with orthopnea, elevated jugular venous pressure, and a palpable liver 1 cm below right costal margin. He developed further complications and presented in the emergency with features of atrial fibrillation with fast ventricular rate and congestive heart failure. He sustained cardiac arrest, from which he could not be revived. At autopsy (consented by the next of kin), the heart was grossly overweight weighing 460 g with concentric biventricular hypertrophy and cavity dilatation. All valves were normal except the mitral valve with a well-defined accessory mitral valve tissue (AMVT) along the left outflow, attached firmly to left ventricular wall just beneath the left coronary and noncoronary aortic valves [Figure 1]. This accessory leaflet was in continuity with the native mitral valve, having multiple minor and one major chordae tendineae attached to anterior papillary muscle. Histology of the section taken along the left ventricular outflow tract showed a membranous tissue firmly adherent to the underlying left ventricular cardiac myocytes, except the inferior most portion of the accessory valve tissue [Figure 2].
Figure 1: Gross photograph of the heart cut open along the posterior wall showing the membranous accessory mitral valve tissue (green arrow) adherent firmly to the anterior ventricular wall, separated from the anterior native valve leaflet (blue arrow) by an accessory commissure (thin green arrow). One chordae (thin red arrow) is seen inserted into the native anterior papillary muscle

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Figure 2: Panel of photomicrographs in hematoxylin and eosin staining in (a) and elastic Van Gieson staining in (b). Both photographs have been built-up by putting together multiple low magnification pictures to give a full view of the accessory membranous tissue

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AMVT is a rare congenital malformation diagnosed usually in childhood and may occur in isolation or along with other cardiac malformations.[1] It may remain asymptomatic or cause left ventricular outflow obstruction.[2],[3] Surgical excision and correction of the associated anomalies are the treatment of choice.[4] The indexed case is a rare variant of membranous type of AMVT which was undiagnosed during life, reemphasizing the importance of routine autopsy in documentation of such type of rare congenital anomaly.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Manganaro R, Zito C, Khandheria BK, Cusmà -Piccione M, Chiara Todaro M, Oreto G, et al. Accessory mitral valve tissue: An updated review of the literature. Eur Heart J Cardiovasc Imaging 2014;15:489-97.  Back to cited text no. 1
    
2.
Uslu N, Gorgulu S, Yildirim A, Eren M. Accessory mitral valve tissue: Report of two asymptomatic cases. Cardiology 2006;105:155-7.  Back to cited text no. 2
    
3.
Panduranga P, Eapen T, Al-Maskari S, Al-Farqani A. Accessory mitral valve tissue causing severe left ventricular outflow tract obstruction in a post-stenting patient with transposition of the great arteries. Heart Int 2011;6:e6.  Back to cited text no. 3
    
4.
Hisatomi K, Hashizume K, Tanigawa K, Miura T, Matsukuma S, Yokose S, et al. Asymptomatic and isolated accessory mitral valve tissue in an adult. Gen Thorac Cardiovasc Surg 2016;64:105-8.  Back to cited text no. 4
    

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Correspondence Address:
Kim Vaiphei
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_368_17

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    Figures

  [Figure 1], [Figure 2]



 

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