Abstract

Isolated cleft of the anterior leaflet of the mitral valve is the occurence of mitral cleft without ostium primum or ostio seccundum defect and it is rare.  We present a nine month old boy who 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, tachypnoeaic, dyspnoeaic with basal crepitations. Cadiovascular system examination showed that 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. 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. 

Key words: Cleft, anterior leaflet, mitral valve.