https://orcid.org/0000-0001-9706-3435
We report the case of a 56-year-old male patient who was admitted with severe shortness of breath and paroxysmal dyspnoea. He was diagnosed with rheumatic mitral stenosis combined with supramitral ring. To make a definite diagnosis, a preoperative transoesophageal echocardiography (TEE) examination was performed. TEE showed a membranous structure with an opening diameter of 9 mm (yellow arrow, Panel A) above the hockey-like mitral valve leaflet (red arrow, Panel A). Accelerated blood flow across the supramitral ring and mitral valve orifice can be seen. The 3D TEE view can clearly show the shape of a circular supramitral ring (yellow arrow, Panel B) and thickened mitral leaflet (red arrow, Panel B) from the perspective of the left ventricle. The patient underwent mitral valve replacement through a median thoracotomy. Intraoperative exploration revealed the structure of the supramitral ring (yellow arrow, Panel C). The resected mitral valve showed the rheumatic mitral leaflet and a fibrous supramitral ring (yellow arrow, Panel D). The patient was discharged 7 days postoperative uneventfully.
A mitral ring is a rare type of congenital mitral stenosis. It acts as a constricting ring that allows blood to flow under pressure from the upper left atrium chamber to the lower chamber and into the left ventricle, mimicking mitral stenosis physiology. So when supramitral ring is combined with mitral stenosis, the patient’s clinical symptoms are more severe than those of mitral stenosis alone. This is a rare case of rheumatic mitral stenosis with supramitral ring.
Funding: None declared.
Data availability: The data underlying this article are available within the article.
Author notes
Conflict of interest: None declared.
