PMC10130681_01
Echocardiographic findings of the Case 1. 2-D TTE in the parasternal short-axis view (A), 3-D TEE from the LA perspective in the diastolic phase (B), and the systolic phase (C) showed MV with two orifices (asterisks) and a flail AMVL segment (arrows). 2-D TEE in the 60-degree mid-esophageal view (D) showed MV with two openings, and jet flows. 2-D TEE in the 60-degree mid-esophageal view (E) and with the color flow (F) showed a flail AMVL segment (arrows), causing a severe mitral regurgitant jet. AV, aortic valve; TTE, transthoracic echocardiogram; TEE, transesophageal echocardiogram; LA, left atrium; MV, mitral valve; AMVL, anterior mitral valve leaflet.
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The transthoracic and transesophageal echocardiogram depicted DOMV with a severe posteriorly directed jet mitral regurgitation (MR) resulting from the ruptured chordae tendineae of the lateral scallop of the anterior mitral valve leaflet (AMVL) (Figure 1A-1F).
PMC10130681_02
Echocardiographic and CMR findings of Case 2. 2-D TTE in the parasternal short-axis view (A), 2-D and color flow TTE in the apical-2-chamber view (B,C) showed MV with two orifices (asterisks), openings (arrows), and jet flows. 3-D TEE from the LA perspective (D) showed the relationship of DOMV with nearby structures. CMR with gradient echo cine image (E) and phase-contrast image (F) in the short-axis view across MV showed MV with two orifices (asterisks). AV, aortic valve; CMR, cardiac magnetic resonance; TTE, transthoracic echocardiogram; MV, mitral valve; TEE, transesophageal echocardiogram; LA, left atrium; DOMV, double orifice mitral valve.
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The study unexpectedly revealed a complete bridge-type DOMV without concomitant mitral stenosis (MS) nor MR (Figure 2A-2D). The phase-contrast image across the MV orifice nicely demonstrated a 2-orifice MV separated by a tissue bridge at the annulus, confirming the DOMV (Figure 2E,2F).