AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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The TEE shows severe mitral regurgitation, trace of aortic regurgitation and a trace of tricuspid regurgitation. The A1 scallop of the mitral valve is exhibiting prolapse. The aortic valve has Lambl's excressences. The TEE also shows a membranous ventricular septal aneurysm.
Zhang repaired anterior mitral valve leaflet prolapse by utilizing chordal transfer in 21 patients. 1 patient had a mitral valve replacement. All of the other patients had good results based upon MV area ((3.3-4.8 cm2), mitral regurgitation (jet area 0.45 cm2), decreased LV dimension, and decreased LA dimension.
Zonghua compared chorda shortening to chorda replacment and found that chordal replacement resulted in superior results for anterior mitral valve leaflet prolapse. The chordal replacement group had better 5 year survival and slightly more freedom from operation than the chordal shortening group.
Morimoto studied multiple repair techniques in anterior mitral valve prolapse ranging from chordal replacement, transfer, shortening to resection, folding, and Alfieri repair. He noted 95% and 89% survival at 10 and 15 years after the repair.
Most membranous septal aneurysms are considered a rare congenital anomaly. The membranous septum is the weakest portion of the septum and separates the right and left ventricles and also the left ventricle and the right atrium behind the tricupsid valve. A LV to RA defect is called a Gerbode defect. The membranous septal aneurysm is usually small (1-3 cm) but can become larger and occlude the RVOT. Membranous septal aneurysms can be acquired by infection, trauma, or myocardial infarction. The membranous septal aneurysm may have a VSD. Membranous septal aneurysms have been associated with aortic regurgitation, membranous subaortic stenosis, complete AV block, mongolism, coarctation of the aorta and thromboembolism.
Other etiologies for the membranous septal aneurysm may be the closure of a VSD by the membranous septum. The VSD spontaneously closes and leaves behind a membranous septal aneurysm.
Membranous septal aneurysms have been associated with fatal ventricular tachyarrhtyhmias.
The recommendations are to repair the mitral valve A1 scallop but not repair the membranous septal aneurysm.
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Aneurysm of the membranous ventricular septum.
Ventricular septal defect associated with aneurysm of the membranous septum
Importance of (perimembranous) ventricular septal aneurysm in the natural history of isolated perimembranous ventricular septal defect
Aneurysm of membranous interventricular septum
Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients.
[Efficacy of mitral valve repair for anterior leaflet prolapse of mitral valve].
[Repair of anterior leaflet mitral valve prolapse: the comparison between chordal replacement and chordal shortening].
Mitral valve repair for anterior leaflet prolapse: surgical techniques review and 16-year follow-up results.