Intractable Heart Failure From a Severe Mitral Paravalvular Leak in Surgically Created Bipartite Left Atrium.

We describe a 38-year-old Middle Eastern woman with a long history of multiple cardiac surgical procedures for mitral valve disease who presented with intractable heart failure from severe mitral paravalvular regurgitation requiring multiple medical admissions since 2019. She was deemed a very high surgical risk and was treated successfully with a percutaneous technique. (Level of Difficulty: Advanced.).

Mitral arcade in adults -- a systematic overview.

Mitral arcade (MA) is a rare congenital anomaly of the mitral valve and its tensor apparatus. This condition has been reported primarily in children younger than 3 years of age. MA is characterized by elongated papillary muscles connected to each other and to the tip of anterior mitral leaflet by a bridge of fibrous tissue. Because of progressive mitral regurgitation and/or mitral stenosis, survival into adulthood is rare. Not much is known about MA in the adult population. In this review we address the demographic features, clinical presentation, diagnosis, treatment, and outcome of this congenital anomaly in adult patients.

Right Ventricular Compression Observed in Echocardiography from Pectus Excavatum Deformity

Pectus excavatum exists as varying anatomic deformities and compression of the right heart by the chest wall can lead to patient symptoms including dyspnea and chest pain with exertion. Echocardiography can be difficult but is critical to the evaluation and diagnosis of this patient population. Modifying standard views such as biplane transthoracic and 3-D transesophageal views may be necessary in some patients due to limitations from the abnormal anatomy of the deformed anterior chest wall. Apical four-chamber views when seen clearly can usually visualize any extrinsic compression to the right ventricle of the heart.