Case report:
The patient was a 19 years old woman who referred to advanced
echocardiography lab due to a history of heart murmur and a mass
attached to anterior mitral leaflet at previous transthoracic
echocardiography. Patient didn’t have fever, anorexia, weakness, and
peripheral stigmata of infective endocarditis or history of emboli.
After first echocardiography, patient had been evaluated for infective
endocarditis and non-bacterial thrombotic endocarditis (NBTE). All
laboratory findings including erythrocyte sedimentation rate (ESR),
C-reactive protein (CRP), complete blood count (CBC), blood cultures,
renal function tests, and screening test for Systemic lupus
erythematosus were normal. Ultrasonography of abdomen and pelvic were
normal. She underwent transthoracic and transesophageal echocardiography
at our center which showed a large mobile oval shape accessory mitral
valve, measured about 18 mm that attached to ventricular surface of the
anterior mitral leaflet (Movie clips 1,2). AMV was echogenic, with
echo-free central part (cyst-like) and sharp borders which resembles the
mitral valve (Figures 1,2). LVOT evaluation with color doppler showed
turbulent flow without significant stenosis (mean pressure
gradient=13mmHg, peak pressure gradient=22mmHg). Aortic valve was
bicuspid with moderate aortic regurgitation without stenosis. There was
a raphe between left coronary cusp (LCC) and right coronary cusp (RCC).
Ascending aorta diameter was normal. Evaluation for coarctation of aorta
was negative. Mitral valve function was normal without stenosis or
regurgitation. At examination, it was a blowing type diastolic murmur
along with ejection sound and midsystolic murmur grade II at upper left
sternal border (LSB). Despite these findings, patient was asymptomatic.