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| http://dx.doi.org/10.1016/j.xjtc.2020.08.012 | DOI Listing |
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Biventricular Dysfunction Due to Chronic Mitral Valve Regurgitation Caused by Aberrant Mitral Arcade.
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Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade.
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For adults, the standard procedure for mitral valve repair of Carpentier classification type II mitral regurgitation is reconstruction with artificial chordae. In children, placement of artificial chordae of precise length between the papillary muscle and prolapsed mitral leaflet in the restricted mitral subvalvular space is technically difficult. We successfully performed mitral valve repair in 3 pediatric patients using a modified fixed loop-in-loop technique.
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A male in his seventies presented with lung cancer in the right lower lobe. The surgically resected specimen revealed a pleomorphic carcinoma featuring an adenocarcinoma component with lepidic, acinar, and papillary patterns, alongside a spindle cell component spreading along the pulmonary artery wall, resembling intimal sarcoma. The spindle tumor cells were positive for keratins, TTF-1, napsin A, and vimentin, but negative for p40, CK14, desmin, alpha-smooth muscle actin, CDK4, and MDM2.
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