DİSCUSSİON
AMLC without congenital heart disease is diagnosed very rare. It characterizes by a cleft on the anterior mitral valve leaflet that is not associated with an ostium primum atrial septal defect or atrioventricular septal defect. It is thought to develop as a result of incomplete expression of the endocardial cushion defect. The mitral annulus is usually in a normal position. The prevalence of AMLC is unknown. (4, 5)
In patients with isolated AMLC, if mitral regurgitation is not severe, patients can remain asymptomatic for years and the diagnosis can be made incidentally. Patients with AMLC tend to have more severe regurgitation than patients with posterior mitral cleft. (5)
Echocardiography is the main diagnostic tool in patients with suspected or known congenital mitral valve disease. Echocardiography provides information about valve anatomy and morphology, mitral regurgitation severity, and presence of other congenital heart disease. The diagnosis of mitral cleft using 2D TTE is particularly challenging. It may not be possible in every patient to obtain a high-resolution mitral valve image and to clearly visualize the anterior and posterior leaflets in the parasternal short axis image. 3D TEE imaging provides the most valuable information in the evaluation of mitral apparatus anatomy, determination of the presence of cleft, quantitative evaluation of mitral regurgitation, whether the valve is suitable for repair and the valve can be seen anatomically with “surgeon’s view”. (1, 2, 4-8)
When feasible, surgical repair is the first option of the treatment, it consists of a direct suture of the cleft with or without insertion of a prosthetic ring. (5, 9, 10)