Congenital Mitral Insufficiency with Cleft Posterior Leaflet

A case of congenital mitral insufficiency in a 2-year-old infant is reported. No other intracardiac defect was found, although pressure studies suggested an area of supravalvular aortic stenosis. Diagnostic studies included combined right and left heart catheterization. Dye-dilution curves confirmed the presence of mitral insufficiency. The anatomic defect, a cleft posterior leaflet of the mitral valve, was repaired by direct suture of the valve leaflet. During 18 months of postoperative observation, the child has shown symptomatic improvement and decrease in the size of the left ventricle, although a systolic mitral murmur and left atrial enlargement persist. Residual insufficiency is probably due to short chordae that restrict mobility of the posterior leaflet.