Key result
TEE identifies coexisting parachute and arcade mitral valve causing severe subvalvular stenosis in young adult.
Case Report (n=1)
Demonstrates the value of detailed transesophageal echocardiography in identifying rare, coexisting congenital mitral valve anomalies such as arcade and parachute pathologies.
Detailed TEE evaluation may uncover rare coexisting congenital mitral anomalies in young adults; leaves open optimal management for this presentation.
A 26-year-old woman presented with heart murmur since childhood and occasional palpitations. Physical examination was notable for soft pan-systolic murmur at the apex. Electrocardiogram was normal. Transthoracic echocardiography (TTE) revealed suspected parachute mitral valve (Figure 1) with moderate mitral stenosis with mild-moderate mitral regurgitation, normal biventricular systolic function, moderately dilated left atrium, and mild pulmonary hypertension. Detailed transesophageal echocardiogram (TEE) was performed, showing mitral valve parachute (dominant anterolateral papillary muscle with majority of attachments) and arcade (shortened, thickened, and rudimentary chordae), both contributing to severe subvalvular mitral stenosis (gradients 26/13 mm Hg) with moderate mitral regurgitation.
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Khurana et al. (2024) conducted a case report in Congenital mitral pathologies (arcade and parachute) (n=1). Transesophageal echocardiography was evaluated on Diagnosis of mitral valve parachute and arcade. Transesophageal echocardiography revealed coexisting parachute and arcade mitral valve pathologies causing severe subvalvular mitral stenosis (gradients 26/13 mm Hg) in a 26-year-old woman.
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