Case Report: Transthoracic echocardiographic diagnosis of agenesis of mitral chordae tendineae with papillary muscle fusion

Figures

• 

  Figure 1. Preoperative echocardiographic findings of the patient (A–I). (A) In the apical four-chamber view, redundant mitral valve leaflets are observed, with no definitive subvalvular chordae tendineae identified; the leaflets insert directly onto the papillary muscles. (B) Mitral valve orifice area (MVOA) is measured at approximately 0.463 cm2 via X-plane imaging. (C) Three-dimensional echocardiography (3DE) confirms mitral stenosis, with a planimetered mitral orifice area of approximately 0.422 cm2. (D) CWD demonstrates markedly elevated antegrade mitral flow, with a peak velocity of 297 cm/s and a corresponding peak transvalvular pressure gradient of 35 mmHg. (E) Moderate-to-severe mitral regurgitation is visualized in the apical four-chamber view, with vena contracta width of 6.6 mm. (F) Parasternal short-axis view at the papillary muscle level identifies two papillary muscle groups, which are confluent at the posterior aspect of the left ventricle. (G) The apical four-chamber view reveals severe tricuspid regurgitation. (H) CWD detects a peak tricuspid regurgitation velocity of 460 cm/s, yielding a peak transtricuspid pressure gradient of 85 mmHg. I: Subxiphoid view demonstrates a…

• 

  Figure 2. Intraoperative findings of the patient. (A) Following incision of the anterior mitral leaflet, the leaflet was found to insert directly onto the papillary muscles, with complete absence of chordae tendineae. (B) Intraoperative visualization of the stenotic mitral valve orifice. Triangle denotes the mitral valve leaflet; arrow indicates the papillary muscle.

• 

  Figure 3. Clinical timeline of the patient's presentation, diagnosis, and management.