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Echocardiographic characteristics and outcome of straddling mitral valve

Alain Fraisse, MD^{* c}, Pedro J. del Nido, MD, PhD ^c, Jean Gaudart, MD and Tal Geva, MD, FACC^{* c}

^* Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
Department of Cardiac Surgery, Children’s Hospital, Boston, Massachusetts, USA
^c Departments of Pediatrics and Surgery, Harvard Medical School, Boston, Massachusetts, USA
Laboratoire de Biomathématiques, Université de la Méditeranée, Marseille, France

View larger version (119K): [in a new window]   Figure 1 Straddling mitral valve in a patient with double outlet right ventricle and {S,D,D} segmental anatomy. (A) Subxiphoid long-axis view showing levocardia, situs solitus of the atria with a right-sided right atrium (RA), left-sided left atrium (LA), and D-ventricular loop. The mitral valve is seen entering the left ventricle (LV). (B) Cranial angulation of the transducer demonstrates straddling of the MV into the infundibulum (Inf). PA = pulmonary artery; S/A = superior/anterior; S/P = superior/posterior; R = right; TV = tricuspid valve.

View larger version (107K): [in a new window]   Figure 2 Echocardiogram in a patient with straddling mitral valve (MV) and {S,D,L} segmental anatomy. (A) Subxiphoid long-axis view showing dextrocardia, left-sided left atrium (LA) with an MV that enters an inferior left ventricle (LV). The right ventricle inflow (RVi) is superior to the LV and the ventricular septum is horizontal (superior-inferior ventricles). Notice that the tricuspid valve (TV) is seen in a "short-axis" orientation whereas the MV is seen in a "long-axis" orientation. This indicates that the axes of the MV and TV are angled relative to each other, typical for criss-cross atrioventricular relations. (B) Clockwise rotation of the transducer from the long-axis plane demonstrates major straddling of the MV into a large left-sided infundibulum (Inf). L/A = left/anterior; R = right; S = superior.

View larger version (126K): [in a new window]   Figure 3 Straddling mitral valve in a patient with double-outlet right ventricle {S,L,L} segmental anatomy and straddling of both anterior (white arrow) and posterior (black arrow) mitral leaflets. Ao = aorta; Inf = infundibulum; LV = left ventricle; RA = right atrium.

View larger version (86K): [in a new window]   Figure 4 Straddling mitral valve (MV) associated with double-outlet right ventricle and {S,L,D} segmental anatomy. (A) Cranial angulation of the transducer in the subxiphoid long-axis plane shows straddling of the MV into a right-sided infundibulum (Inf). Notice the rightward position of the aorta (Ao). (B) Parasternal long-axis view showing the posterior MV leaflet entering the left ventricle (LV) (open arrow) and the anterior MV leaflet inserting into the infundibulum (Inf) (white arrow). A = anterior; R = right.

View larger version (12K): [in a new window]   Figure 5 Kaplan-Meier curve (with 90% confidence intervals) showing the probability of survival of 46 patients with straddling mitral valve.