Diagnostic Considerations

Important considerations

It is important to identify double orifice mitral valve as the cause of mitral valve obstruction or regurgitation or as an associated defect in patients with atrioventricular-canal defect and other congenital heart diseases (CHDs).

Identify and recognize associated abnormalities of the mitral valve apparatus in patients with DOMV.

Special concerns

Double orifice mitral valve may not be detected easily in children with CHDs; therefore, awareness of the problem and careful echocardiographic screening are important in all children with mitral valve disease.

Differential Diagnoses

Workup

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Media Gallery

Double Orifice Mitral Valve. Two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
Double Orifice Mitral Valve. Two-dimensional echocardiogram (parasternal short-axis view) shows a double-orifice mitral valve, the orifice divided by a bridge of tissue.
Double Orifice Mitral Valve. Two-dimensional echocardiogram of a double-orifice mitral valve (apical view) with color flow mapping, which shows diastolic flow through two separate orifices.
Double Orifice Mitral Valve. Two-dimensional echocardiogram (parasternal short-axis view) in a patient with duplicate mitral valve. This diastolic frame shows two typical mitral valve orifices opening into the left ventricle. The two orifices are placed apart, unlike the more common type of double orifice mitral valve (see image above) where the orifice is divided by a bridge of tissue.
Double Orifice Mitral Valve. Real-time two-dimensional echocardiogram (apical view) in a patient with duplicate mitral valve. Two mitral valves can be seen opening into the left ventricle. Each valve has a separate annulus, and a separate set of mitral valve leaflets and subvalvar apparatus.
Double Orifice Mitral Valve. Real-time two-dimensional echocardiogram (subcostal short-axis view) in a patient with duplicate mitral valve showing two typical mitral valves opening into the left ventricle. The two orifices are placed apart, unlike the more common type of double orifice mitral valve (see the previous image) where the orifice is divided by a bridge of tissue.

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Author

Georgios A Hartas, MD, FACC, FSCAI, FAAP Pediatric Interventional Cardiologist, Children's Heart Clinic

Georgios A Hartas, MD, FACC, FSCAI, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Coauthor(s)

Syamasundar Rao Patnana, MD Professor of Pediatrics and Medicine, Division of Cardiology, Emeritus Chief of Pediatric Cardiology, University of Texas Medical School at Houston and Children's Memorial Hermann Hospital

Syamasundar Rao Patnana, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American College of Cardiology, American Heart Association, Society for Cardiovascular Angiography and Interventions, Society for Pediatric Research

Disclosure: Nothing to disclose.

Duraisamy Balaguru, MBBS, MRCP, FACC, FAAP, FSCAI Physician in Pediatric Medicine, Division of Pediatric and Congenital Cardiology, Massachusetts General Hospital, Massachusetts General Hospital for Children, Harvard Medical School

Duraisamy Balaguru, MBBS, MRCP, FACC, FAAP, FSCAI is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Stroke Association, Council on Lifelong Congenital Heart Disease and Heart Health in the Young (AHA), International Society of Invasive Cardiology in Congenital Heart Disease, Pediatric Cardiac Intensive Care Society, Society for Cardiovascular Angiography and Interventions, World Society for Pediatric and Congenital Heart Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Julian M Stewart, MD, PhD Associate Chairman of Pediatrics, Director, Center for Hypotension, Westchester Medical Center; Professor of Pediatrics and Physiology, New York Medical College

Julian M Stewart, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Autonomic Society, American Physiological Society

Disclosure: Received research grant from: Lundbeck Pharmaceuticals<br/>Received grant/research funds from Lundbeck Pharmaceuticals for none.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

Juan Carlos Alejos, MD Clinical Professor, Department of Pediatrics, Division of Cardiology, University of California, Los Angeles, David Geffen School of Medicine

Juan Carlos Alejos, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation

Disclosure: Received honoraria from Actelion for speaking and teaching.