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Shirwaiker A, Goh IHS, Cieslik LK, Appelbe A. Left atrial mitral valve chordae: An important congenital abnormality mimicking endocarditis on transthoracic echocardiography-Case report. Echocardiography 2023; 40:1137-1139. [PMID: 37646444 DOI: 10.1111/echo.15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
A 59-year-old male was incidentally diagnosed with a left atrial mitral valve chordae involving the junction of the A1 and A2 mitral valve leaflets and resulting in moderate mitral regurgitation. The recognition of this extremely rare congenital malformation prevented over diagnosis and overtreatment.
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Affiliation(s)
- Anita Shirwaiker
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Ian Hong Siang Goh
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | | | - Alan Appelbe
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
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Aranda-Domene R, Minano-Frutos C, Arribas-Leal JM, Pérez-Andreu J, Taboada-Martín R, Alfonso-Colomer L, Moreno-Moreno J, Canovas S. Accessory left atrial cords: A case report and literature review. J Card Surg 2022; 37:2437-2439. [PMID: 35578332 DOI: 10.1111/jocs.16608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies. METHODS We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021. RESULTS According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found. CONCLUSION Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.
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Affiliation(s)
- Ramón Aranda-Domene
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Celia Minano-Frutos
- Anesthesiology and Reanimation Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - José M Arribas-Leal
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Joaquín Pérez-Andreu
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Rubén Taboada-Martín
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Laura Alfonso-Colomer
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - José Moreno-Moreno
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Sergio Canovas
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
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Yetkin E, Cuglan B, Turhan H, Yalta K. Accessory mitral valve tissue: anatomical and clinical perspectives. Cardiovasc Pathol 2020; 50:107277. [PMID: 32882373 DOI: 10.1016/j.carpath.2020.107277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/14/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
Mitral valve is a complex cardiac structure composed of several components to work in synchrony to allow blood flow into left ventricle during diastole and not to allow blood flow into left atrium during systole. Accessory mitral valve tissue (AMVT) was defined as existence of any additional part and parcel of valvular structure which has an attachment to normal mitral valve apparatus in left-sided cardiac chambers. AMVT may present itself in different clinical circumstances ranging from a silent clinical course to thromboembolic events, heart failure, left ventricular outflow tract obstruction, and severe arrhythmia. This article reviews the clinical perspectives of AMVT in terms of symptoms, diagnosis, and treatment, providing a new anatomical classification regarding the location of AMVT. Briefly type I refers to AMVT having attachments on the supra leaflets level, type II refers to attachments on the mitral leaflets, and type III refers to attachment below the mitral leaflets. Increased awareness and widespread use of echocardiographic techniques would increase recognition of AMVT in patients with heart murmurs but otherwise healthy and in those with left ventricular outflow tract obstruction or tissue which causes subaortic stenosis and with unexplained cerebrovascular events.
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Affiliation(s)
- Ertan Yetkin
- Istinye University, Faculty of Medicine Department of Cardiology, Istanbul Turkey.
| | - Bilal Cuglan
- Beykent University, Faculty of Medicine Department of Cardiology, Istanbul Turkey
| | - Hasan Turhan
- Istinye University, Faculty of Medicine Department of Cardiology, Istanbul Turkey
| | - Kenan Yalta
- Trakya University, Faculty of Medicine Department of Cardiology, Edirne Turkey
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Hurtado-Sierra D, Fernández-Gómez Ó, Manrique-Rincón F, Vázquez-Antona CA, Buendía-Hernández A. Cuerda auricular izquierda accesoria: causa infrecuente de insuficiencia mitral en niños. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:156-157. [DOI: 10.1016/j.acmx.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/19/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022] Open
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D'Onghia G, Martin M, Mancini MT, Quintarelli S, Cozza A, Guarracini F, Bonmassari R. A late presentation of congenital cardiac anomaly: Accessory chordae from the left atrium causing severe mitral regurgitation. Echocardiography 2018; 35:750-752. [PMID: 29569266 DOI: 10.1111/echo.13869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Mitral regurgitation secondary to accessory mitral valve (MV) chordae of the left atrium is an extremely rare congenital disease. A 85-year-old female (NYHA I-II) was hospitalized for investigations. An echocardiogram showed calcification of the MV with mild stenosis and moderate regurgitation. Transesophageal three-dimensional echocardiogram revealed a band-like structure extending from the distal third of the anterior wall of the left atrium to the MV. This accessory chordae determined severe systolic regurgitation and mild mitral stenosis. The patient was referred for consideration of cardiac surgery but was refused for comorbidities and anatomy. Usually aberrant chordae determinant valvulopathies are detected and treated at a much younger age. The delay of the symptoms could be explained in our case with the progressive growth and dilatation of the left atrium causing traction of the aberrant chord resulting in an increase in the leaflet prolapse and regurgitation.
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Baxi AJ, Tavakoli S, Vargas D, Restrepo CS. Bands, Chords, Tendons, and Membranes in the Heart: An Imaging Overview. Curr Probl Diagn Radiol 2015; 45:380-391. [PMID: 26433812 DOI: 10.1067/j.cpradiol.2015.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Crests, bands, chords, and membranes can be seen within the different cardiac chambers, with variable clinical significance. They can be incidental or can have clinical implications by causing hemodynamic disturbance. It is crucial to know the morphology and orientation of normal structures, aberrant or accessory muscles, and abnormal membranes to diagnose the hemodynamic disturbance associated with them. Newer generation computed tomographic scanners and faster magnetic resonance imaging sequences offer high spatial and temporal resolution allowing for acquisition of high resolution images of the cardiac chambers improving identification of small internal structures, such as papillary muscles, muscular bands, chords, and membranes. They also help in identification of other associated complications, malformations, and provide a road map for treatment. In this article, we review cross-sectional cardiac imaging findings of normal anatomical variants and distinctive imaging features of pathologic bands, chords, or membranes, which may produce significant hemodynamic changes and clinical symptomatology.
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Affiliation(s)
- Ameya Jagdish Baxi
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX.
| | - Sina Tavakoli
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Daniel Vargas
- Department of Radiology, University of Colorado Hospital, Denver, CO
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
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Kim TS, Cho KR, Lim DS. Double accessory left atrial chordae tendineae resulting in mitral regurgitation. Ann Thorac Surg 2014; 97:e5-6. [PMID: 24384221 DOI: 10.1016/j.athoracsur.2013.08.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 07/29/2013] [Accepted: 08/21/2013] [Indexed: 11/16/2022]
Abstract
The presence of accessory left atrial chordae tendineae inserting into the mitral valve leaflet is extremely rare. Two long and thin accessory chordae tendineae, one arising from the left atrial dome and the other from the inferior interatrial septum, were incidentally identified during corrective surgery for severe mitral regurgitation from A3 prolapse. Triangular resection of the A3 portion of the anterior mitral valve leaflet including the double accessory chordae tendineae and primary repair followed by posterior ring annuloplasty was successfully performed.
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Affiliation(s)
- Tae Sik Kim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon City, Republic of Korea
| | - Kwang Ree Cho
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon City, Republic of Korea.
| | - Dal Soo Lim
- Department of Cardiology, Sejong General Hospital, Sejong Heart Institute, Bucheon City, Republic of Korea
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