Biventricular Dysfunction Due to Chronic Mitral Valve Regurgitation Caused by Aberrant Mitral Arcade

Abstract

A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade. Post bypass, left ventricular dysfunction was addressed by intraaortic balloon pump placement and delayed sternal closure. Post chest closure echocardiography showed no residual mitral regurgitation and restored biventricular function. This case highlights a rare presentation of mitral regurgitation with unique anatomical anomaly, successfully managed with a comprehensive surgical approach.

Figure 1

(A) Transesophageal echocardiographic image showing restricted motion of the posterior leaflet and bulging over annular plane, causing malcoaptation (white arrow). (B) Color doppler image showing anteriorly directed and central regurgitant jets.

Figure 2

The intraoperative image showing that the posterior mitral leaflet (PML) without chordae and directly connected to anterolateral papillary muscle with posterior leaflet restriction, while the anterior mitral leaflet (AML) had intact and normal chordal insertion. The pseudo cleft is shown closed with running monofilament suture.

Figure 3

Postrepair image after pseudo cleft closure on P2 segment and posterior annuloplasty with a flexible posterior annuloplasty band. Saline test revealed a competent mitral valve.