Key result
Double orifice mitral valve exhibits diverse presentations ranging from conservative management to surgical replacement.
Why the study?
Double orifice mitral valve (DOMV) is a rare congenital heart disease with variable severity and treatment approaches that require detailed echocardiographic evaluation.
Case Report (n=2)
Double orifice mitral valve can present with varying severity, ranging from severe mitral regurgitation requiring surgical replacement to asymptomatic cases that can be managed conservatively.
Variable DOMV severity supports individualized management; leaves open need for prospective data on asymptomatic cases.
Background: Double orifice mitral valve (DOMV), a rare congenital heart disease, is characterized by a 2-orifice mitral valve (MV) separated by a tissue bridge, causing a spectacles-like morphology. DOMV can present with various severity ranging from asymptomatic to severe valvular dysfunction including mitral regurgitation (MR) and mitral stenosis (MS), as well as symptoms from coexisting congenital anomalies. Echocardiography is the mainstay of the investigation for a DOMV. We described two cases with DOMV who presented with different disease severity resulting in different treatment decisions. Case Description: In the first case, a 52-year-old woman presented with overt left-sided heart failure. The echocardiogram revealed DOMV with ruptured chordae tendineae of the anterior mitral valve leaflet (AMVL) causing severe MR which led the patient to undergo surgical MV replacement. Intraoperative findings confirmed a diagnosis of DOMV. After surgery, the patient could perform daily activities and light exercises without recurrent heart failure. In the second case, on the other hand, a 36-year-old woman was incidentally diagnosed with DOMV from an echocardiographic workup for symptomatic premature ventricular contraction (PVC). After controlled PVC with radiofrequency ablation, her symptom completely resolved and DOMV was classified as asymptomatic which led to the decision of a watchful waiting strategy. Conclusions: These cases highlight the diversity of DOMV manifestations and the importance of appropriate investigations, particularly echocardiography, to evaluate valvular pathology and contemplating the treatment strategy.
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Theerasuwipakorn et al. (2023) conducted a case report in Double orifice mitral valve (DOMV) (n=2). Surgical mitral valve replacement and watchful waiting was evaluated. Two cases of double orifice mitral valve demonstrated diverse clinical manifestations, with one requiring surgical mitral valve replacement for severe regurgitation and the other managed conservatively.
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