Moreover, circumferential detachment of the septal or anterior leaflets, longitudinal incision of the septal leaflet, subvalvular
tricuspid apparatus detachment (chordae papillary muscle or both) from septum have all been described in prior reports examining the tricuspid valve dysfunction at short term follow up (11).
Pre-procedural assessment is based on Wilkins score, based on 2-D echocardiographic assessment thickening of leaflet, inclusion of subvalvular
apparatus and calcifi-cation, with a score >8 precluding PTMC7.
Before repairing, a careful surgical analysis of the valve is important not only to localize the prolapsed area but also to analyze whole leaflet, annulus, and subvalvular
A transesophageal echocardiogram showed a bicuspid aortic valve with thickened, calcific leaflets and severe regurgitation and a mobile vegetation attached to the mitral valve cordae with subvalvular
Less common sites included mural vegetations involving the right and left atrial walls in 3.0% of the patients, right ventricular outflow tract vegetations in 1 patient, isolated involvement of TV subvalvular
apparatus in 1, a vegetation on the aortomitral curtain in 1 and a periaortic root abscess as a complication in 2.
membranes might or might not accompany.
Operative intervention n Closure of VSD with Gore-Tex patch 4 Closure of ASD by direct suturing (2) or Gore-Tex patch (1) 3 Suturing of PFD 3 Operative repair of coarctation of the aorta 2 Norwood palliation 1 Correction of TAPVR 1 Correction of DORV 1 Pulmonary artery banding 1 Atrial septectomy 1 Resection of subvalvular
aortic stenosis 1 Division of vascular ring 1 Total 19 VSD: ventricular septal defect; ASD: atrial septal defect; PDA: patent ductus arteriosus; TAPVD: total anomalous pulmonary venous drainage; DORV: double outlet right ventricle.
types are the least common, and the aetiology of this condition is uncertain, but it seems to be associated with a congenital weakness of the posterior mitral ring .
This lesion leads to subvalvular
aortic stenosis and usually also to severe aortic incompetence.
Kon and Associates reported that a good exposure of the mitral valve and its subvalvular
apparatus was obtained by superior trans-septal approach.
Wilkins score was obtained by adding the score for each of the individual morphological features as, leaflets mobility, thickness, calcification and subvalvular
Key words: foot clenching, cardiac outflow obstruction, subvalvular
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