Three-dimensional echocardiography in the management of parachute mitral valve

Abstract

Parachute mitral valve (MV) is a rare congenital malformation characterized by a single papillary muscle which receives all mitral chordal attachments. Unique views of the subvalvar MV apparatus can be obtained by three-dimensional (3D) echocardiography which are not achievable by standard cross-sectional 2D echocardiography. An example of this is the demonstration of the papillary muscle and chordal support apparatus in the parachute MV. Panel A shows a short-axis projection of a ‘normal MV’. By cropping a plane (line) anterior to the posteromedial (PM) and anterolateral (AL) papillary muscles, a novel 3D projection is achieved in Panel C, showing the anterior MV leaflet (A), chordal attachments (arrowheads), papillary muscles, and aorta (AO). Analogous projection in a ‘parachute MV’ (Panel B) shows both the medial and lateral margins of the anterior MV leaflet (A) with chordal attachment (arrowheads) to a single AL papillary muscle. Panel D illustrates a long-axis view of the left ventricle and left atrium (LA), revealing the attachments of the lateral aspect of the anterior and posterior MV leaflets to the single lateral papillary muscle (see Supplementary data online, Videos S1–S3).