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Accessory and anomalous atrioventricular valvar tissue causing outflow tract obstruction

Surgical implications of a heterogeneous and complex problem

Doff B. McElhinney, MD^*, V. Mohan Reddy, MD^*, Norman H. Silverman, MD and Frank L. Hanley, MD^*

^* Division of Cardiothoracic Surgery, University of California, San Francisco, California, USA
Division of Pediatric Cardiology, University of California, San Francisco, California, USA

View larger version (67K): [in a new window]   Figure 1 Preoperative echocardiogram in patient 11. (Left) Parasternal long axis view shows an abnormal mass of accessory AV valvar tissue (arrow) ballooning into the left ventricular (LV) outflow tract and across the aortic valve during systole. The open leaflets of the aortic valve are indicated by the double arrow. (Middle) Parasternal short axis view shows the abnormal septal commissure (CL) and the accessory tissue above it. (Right) Subcostal sagittal view demonstrates the papillary muscles (PMs) of the mitral valve, the septal commissure and the mass of accessory tissue protruding into the left ventricular outflow tract (arrow). Ao = aorta; LA = left atrium; PA = pulmonary artery; RV = right ventricle.