Image of the Week: Feb. 27, 2006 -- Mitral Pseudocleft

6 year 12 Kg girl with and ASD and severe mitral regurgitation. Echo showed AML prolapse .

There was a mild fluttering of the PML but exact pathology could not be made out.

On opening and examining via the atrial septal defect there was AML prolapse and also leak via pseudoclefts between the P1/2 and P2/3 scallops. The repair involved closure of the pseudoclefts, Combined chordoplasty with neochordal construction to reduce the AML prolapse, (both papillary muscles). a Carpentier magic stitch at the posteromedial commissure and a Panneth Burr annuloplasty. I elected not to put any "ring" in view of her young age.

She got a competent valve on Echo.

Pseudoclefts are usually effaced in rheumatic pathology and seem to create "leaks" in ischemic MR. This child seemed to leak from these clefts in addition to the AML Prolapse.

A true cleft would not have chordae at its margin.

Submitted by:

Dr. Prasanna Simha M
Sri Jayadeva Institute of Cardiology
Bangalore, India