An isolated cleft of the anterior leaflet of mitral valve in an infant: a case report

Background: Isolated cleft of the anterior leaflet of the mitral valve is the occurrence of mitral cleft without ostium primum or ostium secundum defect and it is rare. It results from various degrees of failure of fusion of early embroyonic atrioventricular endocardial cushions and occurs more in children with trisomy 21. It commonly presents with mitral incompetence which worsens as the child grows. Aim: To document a case of congenital isolated cleft of the anterior leaflet of the mitrial valve in an infant. Findings: A nine month old boy presented in our clinic with a two month history of fast breathing, cough, and loss of weight. He was found not to be cyanosed but pale, tachypnoeic, dyspnoeic with basal crepitations. Cadiovascular system examination revealed he had a precordial bulge with tachycardia, cardiomegaly and a holosystolic murmur maximum at the apex. There was tender hepatomegaly. He was diagnosed as having congestive cardiac failure with broncho- pneumonia secondary to an acyanotic congenital heart disease. Plain chest X-ray confirmed the cardiomegaly and bronchopneumonia while an electrocardiography showed bilateral atrial enlargement with right ventricular hypertrophy. The cardiac failure was treated but he represented with recurrent heart failure upto three times within six months. An echocardiogram done on the third admission showed an isolated cleft of the anterior leaflet of the mitral valve and he has been referred for surgery. Conclusion: Isolated cleft of the mitral valve commonly presents with mitral incompetence and eventual heart failure as in our patient. Early surgical intervention is adviced as the width of the cleft tend to increase as the child grows leading to worsening of the mitral insufficiency. The definitive treatment is direct closure of the cleft. The presentation also highlights the challenges of medical practice in resource-poor countries.