Multidetector CT presentation of a parachute-like asymmetric mitral valve

A 24-year-old man with a complaint of exertional dyspnoea had a Grade III/VI apical pansystolic murmur on physical examination. He underwent a transthoracic echocardiogram, which revealed a funnel-shaped mitral valve with moderately thick leaflet tissue and an eccentric orifice, as well as a bicuspid aortic valve. The mitral valve was mildly stenotic and severely regurgitant. Although demonstration of a single papillary muscle in the parasternal short axis view suggested a parachute mitral valve, the diagnosis was uncertain owing to poor echocardiographic acoustic quality. 16-row multidetector CT (MDCT) clearly demonstrated two papillary muscles and the patient was diagnosed as having a parachute-like asymmetric mitral valve. In conclusion, MDCT can be used as a complementary imaging technique for the evaluation of subvalvular mitral apparatus and papillary muscles, especially in patients with poor echocardiographic acoustic quality.