Mitral Arcade With Anomalous Papillary Muscles

Figures

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  Figure 1. Admission Electrocardiogram

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  Figure 2. Chest Radiograph and Computed Tomographic View

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  Figure 3. Transmitral Gradient and M-Mode of Mitral Valve (A) Mean transmitral gradient 17 mm Hg at a heart rate of 86 beats/min. (B) M-mode of leaflet tips.

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  Figure 4. Sequential Transthoracic Echocardiogram Parasternal Short Axis and 3-Dimensionial Transesophageal Echocardiogram Reconstruction of Mitral Valve “Fish-mouth” appearance of the mitral orifice leading to short thickened chordae tendinae and superiorly displaced anterolateral papillary muscle. Mitral valve area estimated by pressure half-time 1.1 cm2 and measured 1.0 cm2 by 3-dimensional multiplanar reconstruction. Estimated regurgitant orifice area 20 cm by proximal isovelocity surface area method, regurgitant volume 39 mL, regurgitant fraction 43%.

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  Figure 5. Cardiac Computed Tomographic Short Axis Cardiac computed tomographic view short axis showing fibrous band of tissue (arrow) between the papillary muscles.

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  Figure 6. Correlation of Surgical and Computed Tomographic Reconstruction (A) Surgical view of the heads of the hypertrophied papillary muscles after resection of chords to the anterior leaflet, (B) 3-dimensional cardiac computed tomographic reconstruction.

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  Figure 7. Gross Appearance of Mitral Arcade Mitral valve after partial resection of the anterior leaflet showing thick, fibrotic, and cranially displaced papillary muscles with diminutive, thickened chordae.

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  Figure 8. Histology of Resected Mitral Valve Mitral valve with focal myxoid change and fibrosis (hematoxylin and eosin, A: magnification ×100, B: magnification ×200).

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  Figure 9. Histology of Biopsied Lung Lung with intra-alveolar hemosiderin-laden macrophages (hematoxylin and eosin, magnification ×200).