Arq Bras Cardiol Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia PrXGBX7XLTvrt4VscBHxSTr S0066-782X2015000500015 00015 10.5935/abc.20150043 Image Isolated Double Orifice Mitral Valve - a Rare Finding in an Elderly Man Ciobanu Andrea O 1 2 Bennett Sean 3 Lopes Renato D 4 Vinereanu Dragos 1 University of Medicine and Pharmacy Carol Davila Cardiology Department Bucharest Romania University of Medicine and Pharmacy Carol Davila, Bucharest / Cardiology Department, University and Emergency Hospital of Bucharest - Romania National Institute of Pathology Victor Babes Bucharest Romania National Institute of Pathology Victor Babes, Bucharest - Romania King Faisal Cardiac Centre Jeddah Saudia Arabia King Faisal Cardiac Centre, National Guard Health City, Jeddah - Saudia Arabia Duke University Medical Center Duke Clinical Research Institute Durham USA Duke Clinical Research Institute, Duke University Medical Center, Durham - USA University Medical Center Mailing Address: Dragos Vinereanu, University and Emergency Hospital Bucharest. University of Medicine and Pharmacy Carol Davila, Sector 5. Postal Code 050098, Bucharest, Bucharest - Romania. E-mail: vinereanu@gmail.com

Author contributions

Conception and design of the research:Ciobanu AO, Bennett S, Vinereanu D. Acquisition of data:Ciobanu AO, Bennett S. Analysis and interpretation of the data: Ciobanu AO, Bennett S, Lopes RD, Vinereanu D. Writing of the manuscript:Ciobanu AO. Critical revision of the manuscript for intellectual content: Ciobanu AO, Bennett S, Lopes RD, Vinereanu D. Supervision / as the major investigador: Vinereanu D.

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

 05 2015 104 5 e53 e54 19 02 2015 27 02 2015 04 03 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License which permits unrestricted noncommercial use, distribution, and reproduction in any medium provided the original work is properly cited. Mitral Valve/abnormalities Heart Defects, Congenital Aged Echocardiography, Three-Dimensional/methods European Social Fund 141531 Romanian Government 141531 05 2015

We present herein several transesophageal echocardiogram (TEE) images of a 60-year-old man referred to the cardiac surgeon for a triple coronary artery bypass graft procedure, in which a normally-functioning double orifice mitral valve (DOMV) was an incidental finding during routine intraoperative TEE. This is a very rare congenital malformation, even rarer as an isolated anomaly in an elderly patient. Three-dimensional TEE (3D-TEE) confirmed the diagnosis and provided complete and fast assessment of the mitral valve and the surrounding structures and all the information needed to reassess the surgical strategy in the very short pre‑bypass period.

Real-time 3D-transesophageal echocardiogram „en face" view from the left atrium („surgeon's view", Panel A) and from the LV (Panel B) revealing two asymmetrical orifices, a smaller lateral (1) and a bigger medial (2) mitral orifice, separated by fibrous tissue (arrow). Panel C- achieved after using a sagittal crosssectional plane to "split" the valve and the LV in two for better view of the orifices and unrestricted opening of the mitral valve. Panel D. 2D (left) and 3D-zoom mode (right) transgastric view of the two orifices. LV, left ventricle. Acknowledgement

This paper is partly supported by the Sectorial Operational Programme of Human Resources Development (SOPHRD), financed by the European Social Fund and the Romanian Government under contract number POSDRU 141531.

Sources of Funding

There were no external funding sources for this study.

Study Association

This study is not associated with any thesis or dissertation work.

 Válvula Mitral de Duplo Orifício Isolado - Um Achado Raro em um Homem Idoso Ciobanu Andrea O 1 2 Bennett Sean 3 Lopes Renato D 4 Vinereanu Dragos 1 University of Medicine and Pharmacy Carol Davila Cardiology Department Bucharest Romania University of Medicine and Pharmacy Carol Davila, Bucharest / Cardiology Department, University and Emergency Hospital of Bucharest - Romania National Institute of Pathology Victor Babes Bucharest Romania National Institute of Pathology Victor Babes, Bucharest - Romania National Guard Health City King Faisal Cardiac Centre Jeddah Saudia Arabia King Faisal Cardiac Centre, National Guard Health City, Jeddah - Saudia Arabia Duke University Medical Center Duke Clinical Research Institute Durham USA Duke Clinical Research Institute, Duke University Medical Center, Durham - USA Correspondência: Dragos Vinereanu, University and Emergency Hospital Bucharest. University of Medicine and Pharmacy Carol Davila, Sector 5. Postal Code 050098, Bucharest, Bucharest - Romania. E-mail: vinereanu@gmail.com

Contribuição dos autores

Concepção e desenho da pesquisa:Ciobanu AO, Bennett S, Vinereanu D. Obtenção de dados: Ciobanu AO, Bennett S. Análise e interpretação dos dados: Ciobanu AO, Bennett S, Lopes RD, Vinereanu D. Redação do manuscrito: Ciobanu AO. Revisão crítica do manuscrito quanto ao conteúdo intelectual importante:Ciobanu AO, Bennett S, Lopes RD, Vinereanu D. Supervisão / como investigador principal: Vinereanu D.

Potencial Conflito de Interesse

Declaro não haver conflito de interesses pertinentes.

 Valva mitral/anormalidades Cardiopatias Congênitas Idoso Ecocardiografia Tridimensional/métodos European Social Fund 141.531 Governo romeno 141.531

Apresentamos aqui várias imagens de ecocardiografia transesofágica (ETE) de um homem de 60 anos encaminhado para o cirurgião cardíaco para procedimento de revascularização coronariana com triplo enxerto, durante o qual uma válvula mitral de duplo orifício (VMDO), funcionando normalmente foi um achado incidental durante a ETE intraoperatória de rotina. Essa é uma malformação congênita rara, ainda mais rara como uma anomalia isolada em um paciente idoso. A ETE tridimensional (ETE-3D) confirmou o diagnóstico, fazendo uma avaliação completa e rápida da válvula mitral e das estruturas vizinhas, e fornecendo todas as informações necessárias para reavaliar a estratégia cirúrgica no curtíssimo período pré-revascularização.

Imagem Transesofágica 3D em tempo real "en face", vista a partir do átrio esquerdo ("visão do cirurgião", Painel A) e do VE (Painel B) revelando dois orifícios mitrais assimétricos, um menor lateral (1) e um maior medial (2), divididos por um tecido fibroso (seta). Painel C- obtido depois de utilizar-se um plano de corte sagital para "dividir" a válvula e o VE em dois para melhor visualização dos orifícios e abertura irrestrita da válvula mitral. Painel D. Vista transgástrica 2D (à esquerda) e 3D (à direita) no modo de zoom dos dois orifícios. VE, ventrículo esquerdo. Agradecimentos

Este trabalho é parcialmente financiado pelo Sectorial Operational Programme of Human Resources Development (SOPHRD), financiado pelo European Social Fund e o Governo romeno sob o contrato número POSDRU 141.531.

Fontes de Financiamento

O presente estudo não teve fontes de financiamento externas.

Vinculação Acadêmica

Não há vinculação deste estudo a programas de pós-graduação.