Description
A 64-year-old woman presented with continuous chest pain. She had a history of type 2 diabetes mellitus. A 12-lead electrocardiogram (ECG) showed ST segment depression in leads V4 to V6, inferior wall, lateral wall. Troponin I (TNI) and Troponin T (TNT) were normal. Two-dimensional TTE performed with a Phillips Epiq 7C ultrasound scanner. A transthoracic echocardiogram showed ventricular aneurysm after anterior myocardial infarction (AMI). Furthermore there was a structure originating from the anterior mitral leaflet, and attaching to the papillary muscles as a redundant spherical cyst-like structure, which matched the diagnostic criteria for an Accessory mitral valve tissue (AMVT). The tissue moved into the left ventricular outflow tract (LVOT) during systole, but did not obstruct flow. Morphological characteristics and motion were suggestive of AMVT with CHD. Accessory mitral valve tissue (AMVT) is a kind of rare congenital cardiac anomaly; however, it may lead to include dyspnea, chest pain, fatigue, palpitations，or syncope. The patients without LVOT obstruction (LVOTO) do not have hemodynamic changes, who is often an incidental finding. AMVT is most often associated with other cardiac and vascular congenital malformations, such as ventricular septal defects, transposition of the great arteries, ebstein anomaly etc. However, AMVT with CHD are rarely. With TTE, AMVT may look like a spherical cyst-like structures floating in the LVOT, which is mobile in the cardiac cycle and attach between the anterior mitral leaflet and intraventricular septum, papillary muscles or left ventricular free wall (LVFW).AMVT is recognized as a cause of LVOTO.
Key Finding(s)
In brief，CHD is common. However，as I know, cases of AMVT with CHD are rarely reported.
Differential Diagnosis
As for differential diagnosis, echocardiography may differentiate AMVT from HCM with LVOTO，redundant MV chordae, vegetations. However，the vegetations more commonly build up directly upon the low-pressure side of a heart valve. And the patient always get a fever.
Implication(s)
Transthoracic echocardiography is a very useful diagnostic test to make a diagnosis about AMVY and CHD.

Echocardiography diagnosis of accessory mitral valve tissue (AMVT) with coronary heart disease（CHD）：report of one case

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.