Description
Accessory mitral valve tissue (AMVT) causing left ventricular outflow tract (LVOT) obstruction and aortic regurgitation (AR) is a rare congenital heart disease. The true prevalence is not well known but latest literature review identified 104 cases of AMVT from 1963 to 2013. Key Finding(s)
We present a case of an asymptomatic 35-year-old female with heart murmur. Echocardiography showed a mobile serpiginous AMVT that parachutes into LVOT with significant gradient of 74 mmHg. There was mild restriction of the aortic right coronary cusp (RCC) with moderate AR. The patient underwent open heart surgery and had an excision of the AMVT and subcommissuroplasty of the RCC. Histological analysis of the excised specimen showed fragments of valvular tissue with fibrosis. There was no obstruction on repeat echocardiography with mild AR. There was no postoperative complication noted and patient was discharged stable. Differential Diagnosis
AMVT in our case may mimic some other diseases that can cause LVOT obstruction. One differential diagnosis hypertrophic obstructive cardiomyopathy (HOCM) which differentiate it from AMVT by intensification of murmur during valsalva or standing. Another differential diagnosis is rheumatic aortic stenosis with aortic regurgitation or a congenital heart disease, bicuspid aortic valve with aortic stenosis. However the midsystolic murmur of aortic stenosis usually radiates to the right carotid and the murmur decreases by standing and during valsalva. Implication(s)
AMVT usually seen among young patients but uncommon among female adult population and may cause LVOT obstruction and AR. Echocardiography is an important diagnostic modality and the optimal treatment is surgery in the presence of significant LVOT obstruction.

Accessory mitral valve tissue with significant left ventricular outflow tract obstruction and aortic regurgitation

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.