Hypoplastic posterior mitral leaflet associated with ostium secundum atrial septal defect

Abstract

Hypoplastic posterior mitral leaflet is a congenital dysplastic mitral valve abnormality rarely reported in adults. The presentation is varied, from being asymptomatic to significantly symptomatic due to progressive mitral regurgitation. In many of these cases additional cardiac lesions are noted, most commonly, bicuspid aortic valve and atrial septal defect. Hence, while performing imaging assessment for these conditions, a comprehensive evaluation of the mitral valve apparatus is essential so as not to miss the valvular pathology. The ideal therapeutic approach and timing for intervention in hypoplastic posterior mitral leaflet is still not clear due to a rarity of these cases. Mitral valve repair though preferred, may not be the ideal treatment modality and many patients require mitral valve replacement especially when presenting at an older age. We hereby report about a 56-year-old male patient who was diagnosed with ostium secundum atrial septal defect and hypoplastic posterior mitral leaflet. He underwent successful surgical closure of the atrial septal defect and concomitant bileaflet metallic prosthetic mitral valve replacement.  His postoperative course was uneventful and was associated with amelioration of symptoms during follow-up.