Isolated congenital anterior mitral leaflet cleft: A rare cause of mitral insufficiency

Background and aim of the study: Isolated cleft of the anterior mitral leaf let is a rare cause of mitral insufficiency. Although an established entity , due to its rarity the exact anatomic diagnosis is difficult to establish unless sought specifically. Methods: Four patients (age range: 16 to 26 years) with isolated cleft of t he anterior mitral leaflet were treated at the authors' institute. Clinical symptoms were typical of mitral insufficiency; the exact anatomic diagnosi s was not established preoperatively in any patient. The cleft was directly sutured in all four patients and additional annuloplasty was performed in three. Results: Postoperative echocardiography confirmed satisfactory results. Aft er a mean follow up of 46.7 months (range: 3 to 84 months), one patient had mild mitral insufficiency and the remaining patients had no mitral regurgi tation. Conclusions: In severe mitral insufficiency with no obvious mitral valve pa thology and an intact atrial septum, a cleft of the anterior mitral leaflet should be sought. Repair of the cleft can restore normal mitral valve func tion.