Tract Obstruction in a Young Adult

Accessory mitral valve (AMV) is a rare cause of left ventricular outflow tract (LVOT) obstruction in childhood and is extremely rare in adults. MacLean et al.1 first described this condition in 1963. At least 63 cases of AMV have been reported in literature. Of these, 59 patients underwent operations, and only 7 were adults.2 In most reported cases, this anomaly was found in the first decade of life, mainly because of a heart murmur.3 This case re-port demonstrates the progression of the AMV causing obstruction to the mitral valve and LVOT in a woman in her early 20s with known congenital heart disease. Case Report Our pediatric cardiologist first saw the patient at the age of nine months for evaluation of a murmur. Prominent systolic and diastolic sounds were noted; the chest x-ray showed mild cardiac enlargement with increased pulmonary vascularity, and electro-cardiogram (EKG) was suggestive of right atrial enlargement. The patient underwent cardiac cathe-terization, which demonstrated the following: evidence of myocardiopathy with hypercontractility of th