SHM Converge Scientific Abstract ePoster Gallery-A Rare Congenital Culprit Cleft Mitral Anterior Leaflet: Behind a New Onset Atrial Fibrillation

Pdf Summary

This case describes a 64-year-old man with a known history of mitral valve prolapse who presented with new-onset atrial fibrillation with rapid ventricular response. He had experienced intermittent palpitations for years and had previously undergone extensive cardiac evaluation, including transthoracic and transesophageal echocardiography. Earlier imaging showed severe mitral regurgitation due to prolapse, but he had declined surgical repair because his symptoms were not significantly limiting.<br /><br />During this admission, he was treated with rate control and anticoagulation, then spontaneously converted to normal sinus rhythm. Repeat transthoracic echocardiography showed preserved left ventricular function with grade II diastolic dysfunction and moderate-to-severe mitral regurgitation. A follow-up transesophageal echocardiogram revealed the true structural cause: severe mitral regurgitation from an anterior mitral valve leaflet cleft, along with posterior leaflet prolapse and flail. After discussion of the findings and the importance of repair, he agreed to proceed with surgical intervention. He was discharged on metoprolol and apixaban.<br /><br />The report emphasizes that an isolated anterior mitral valve leaflet cleft is a rare congenital abnormality, often associated with other congenital heart defects but occasionally found in isolation. Because it can remain undetected for many years, diagnosis may only occur when patients develop symptoms such as palpitations, arrhythmias, or heart failure signs that prompt further imaging.<br /><br />Overall, this case highlights the need to consider uncommon congenital mitral valve defects in adults with unexplained or worsening mitral regurgitation and new arrhythmias, especially when prior studies do not fully explain the clinical picture.

Asset Subtitle

Ashni Dudhia

Meta Tag

Author List Ashni Dudhia, Gerald A. Nelson, Sridevi Pitta

Category Clinical Vignettes

Concept Congenital Anterior Mitral Valve Leaflet Cleft

Concept Mitral Regurgitation

Concept Mitral Valve Abnormality

Concept Severe Mitral Regurgitation

Concept Atrial Fibrillation

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Ashni Dudhia

Track Adult

Keywords

mitral valve prolapse

atrial fibrillation

rapid ventricular response

mitral regurgitation

transesophageal echocardiography

anterior mitral valve leaflet cleft

posterior leaflet prolapse

flail leaflet

congenital heart defect

surgical repair

Congenital Anterior Mitral Valve Leaflet Cleft

Mitral Regurgitation

Mitral Valve Abnormality

Severe Mitral Regurgitation

Atrial Fibrillation