Case report
Isolated congenital mitral leaflet perforation in a young adult: A case report
Perforación congénita aislada de la válvula mitral en una adulta joven: Reporte de un caso
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Flores-Sarria, Diego B. Ortega-Zhindón, Stephanie Angulo-Cruzado, Antonio Benita-Bordes, Jorge L. Cervantes-Salazar" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Iris P." "apellidos" => "Flores-Sarria" ] 1 => array:2 [ "nombre" => "Diego B." "apellidos" => "Ortega-Zhindón" ] 2 => array:2 [ "nombre" => "Stephanie" "apellidos" => "Angulo-Cruzado" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Benita-Bordes" ] 4 => array:2 [ "nombre" => "Jorge L." "apellidos" => "Cervantes-Salazar" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1134009622000936?idApp=UINPBA00004N" "url" => "/11340096/0000003000000001/v1_202302161322/S1134009622000936/v1_202302161322/es/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Isolated congenital mitral leaflet perforation in a young adult: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "50" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Corominas, Manel Tauron, Marta Molina, Juan Francisco Tabilo, Rubén Leta, Antonino Ginel" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Laura" "apellidos" => "Corominas" "email" => array:1 [ 0 => "lcorominas@santpau.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Manel" "apellidos" => "Tauron" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Juan Francisco" "apellidos" => "Tabilo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Rubén" "apellidos" => "Leta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Antonino" "apellidos" => "Ginel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiac Surgery, Universitat Autònoma de Barcelona. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Cardiology, Universitat Autònoma de Barcelona. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perforación congénita aislada de la válvula mitral en una adulta joven: Reporte de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 811 "Ancho" => 805 "Tamanyo" => 128735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Repair of the mitral perforation with bovine pericardial patch and ring annuloplasty.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A congenital perforation on the anterior leaflet is a very rare cause of mitral regurgitation (MR).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> We report the case of a young adult with mitral regurgitation due to an isolated anterior leaflet perforation without any other valve anomaly and with no evidence of previous endocarditis, systemic disease or trauma. The mitral valve was surgically repaired using a pericardial patch and ring annuloplasty.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 20-year-old asymptomatic woman was diagnosed with mitral regurgitation due to a cardiac murmur.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The transthoracic and transesophageal echocardiography (TTE and TEE) identified a Carpentier type I severe MR secondary to an isolated anterior mitral leaflet perforation with ventricular and atrial dilatation (LVEDV index 37<span class="elsevierStyleHsp" style=""></span>mm/m<span class="elsevierStyleSup">2</span>, Left Atrium: 75<span class="elsevierStyleHsp" style=""></span>ml/m<span class="elsevierStyleSup">2</span>), and preserved left ventricular ejection fraction (LVEF 69%). Ventricular septal defects and other cardiac anomalies were excluded. No other mitral valve abnormalities were found. No vegetations were seen, and no previous fever or signs of infective endocarditis were found in the clinical examination (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>, <a class="elsevierStyleCrossRef" href="#sec0045">Online Resource 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the absence of symptoms, the patient was referred for surgical repair due to the significant dilation of left cavities and the severity of the regurgitation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical exploration showed a 7<span class="elsevierStyleHsp" style=""></span>mm isolated perforation in the A2 segment. Free edge and mitral chordae of the anterior leaflet were normal. The entire posterior leaflet, both commissures and the subvalvular apparatus were normal. Mitral annulus was slightly dilated. No visual signs of mitral valve endocarditis were found (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Mitral valve repair was performed by closing the defect with a circular patch of bovine pericardium and continuous suture. A mitral annuloplasty was performed using a 32<span class="elsevierStyleHsp" style=""></span>mm Memo 3D Rechord ring (Sorin Group®) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Intraoperative TEE showed no residual MR or stenosis. As postoperative complications, the patient presented electrocardiographic signs of pericarditis and moderate pericardial effusion without hemodynamic compromise in the TTE, treated with nonsteroidal anti-inflammatory drugs. Patient was discharged on the 5th day after surgery. TTE before discharge revealed a minimal residual mitral regurgitation (<a class="elsevierStyleCrossRef" href="#sec0045">Online Resource 2</a>).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Four months after surgery the patient is in NYHA class I.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Mitral valve leaflet perforation is a rare cause of MR.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Secondary leaflet perforations are normally associated with infective endocarditis, inflammatory or connective tissue diseases and iatrogenic or traumatic lesions.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3</span></a> In some cases, an aortic regurgitation jet as a cause for mitral leaflet perforation has been suggested.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Congenital mitral regurgitation is normally associated with clefts, leaflet malformations, congenital prolapse or chordae or subvalvular malformation.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the reported case, a casual diagnosis of a severe mitral regurgitation due to an isolated anterior mitral leaflet perforation was made. No clinical history or signs of infective endocarditis, trauma or systemic inflammatory disease was found. TTE and TEE revealed an isolated leaflet perforation as a single mechanism for the severe mitral regurgitation. No other valve abnormalities were found either in the mitral or any other valve. The leaflet perforation was believed to be congenital as we were unable to find any other cause for it. Congenital isolated anterior leaflet perforation has been described as cause for mitral regurgitation in children,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> but to the best of our knowledge this is the first case reported in a young adult. In our case, surgical repair was performed closing the defect with a bovine pericardial patch and a ring annuloplasty, with trace residual MR in the postoperative echocardiography.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Isolated anterior leaflet perforation is a very rare cause of mitral regurgitation in adults. Surgical repair with pericardial patch closure and annuloplasty is a safe and effective treatment.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical considerations</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patient written consent for taking pictures for a scientific and formative purpose was obtained, explaining that the any images taken would never be accompanied of potentially identifiable information.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1849473" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1608578" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec1608577" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres1849472" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec1608576" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethical considerations" ] 10 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-04-11" "fechaAceptado" => "2022-06-26" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1608578" "palabras" => array:5 [ 0 => "Perforation" 1 => "Anterior mitral leaflet" 2 => "Mitral regurgitation" 3 => "Congenital" 4 => "Repair" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1608577" "palabras" => array:5 [ 0 => "TTE" 1 => "TEE" 2 => "MR" 3 => "LVEDV" 4 => "LVEF" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1608576" "palabras" => array:5 [ 0 => "Perforación" 1 => "Velo mitral anterior" 2 => "Regurgitación mitral" 3 => "Congénita" 4 => "Reparación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 20-year-old woman was diagnosed with mitral regurgitation due to an anterior mitral leaflet perforation. After completing the preoperative study no clear etiology was found, considering it to be of congenital origin.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Surgical repair was performed with a patch of bovine pericardium and a ring annuloplasty. Serial echocardiograms taken postoperatively showed no regurgitation across the mitral valve.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mujer de 20 años diagnosticada de insuficiencia mitral por perforación de velo mitral anterior. Tras realizar el estudio preoperatorio no se encontró una etiología clara, considerándose de origen congénito.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La reparación quirúrgica se realizó con parche de pericardio bovino y anuloplastia con anillo. Los ecocardiogramas en serie realizados después de la cirugía no mostraron regurgitación residual.</p></span>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0080" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 769 "Ancho" => 1340 "Tamanyo" => 121944 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Preoperative echocardiography showing severe mitral regurgitation.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 721 "Ancho" => 755 "Tamanyo" => 41164 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">3D echocardiography showing the anterior mitral leaflet perforation.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 909 "Ancho" => 805 "Tamanyo" => 143674 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Intraoperative observation of an isolated 7<span class="elsevierStyleHsp" style=""></span>mm leaflet perforation of the A2 segment.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 811 "Ancho" => 805 "Tamanyo" => 128735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Repair of the mitral perforation with bovine pericardial patch and ring annuloplasty.</p>" ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 2241640 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 5 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 2151364 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mitral valve regurgitation in the contemporary era: insights into diagnosis, management, and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 2 | 12 |
| 2024 October | 64 | 14 | 78 |
| 2024 September | 74 | 37 | 111 |
| 2024 August | 58 | 18 | 76 |
| 2024 July | 74 | 21 | 95 |
| 2024 June | 63 | 24 | 87 |
| 2024 May | 67 | 23 | 90 |
| 2024 April | 44 | 23 | 67 |
| 2024 March | 43 | 6 | 49 |
| 2024 February | 36 | 18 | 54 |
| 2024 January | 44 | 2 | 46 |
| 2023 December | 48 | 6 | 54 |
| 2023 November | 44 | 14 | 58 |
| 2023 October | 50 | 36 | 86 |
| 2023 September | 32 | 4 | 36 |
| 2023 August | 31 | 12 | 43 |
| 2023 July | 30 | 8 | 38 |
| 2023 June | 27 | 3 | 30 |
| 2023 May | 30 | 4 | 34 |
| 2023 April | 38 | 6 | 44 |
| 2023 March | 10 | 12 | 22 |
| 2023 February | 16 | 6 | 22 |
| 2023 January | 0 | 7 | 7 |
| 2022 December | 0 | 6 | 6 |
| 2022 November | 0 | 17 | 17 |
| 2022 October | 0 | 0 | 0 |
| 2022 September | 1 | 2 | 3 |
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