Tri-leaflet mitral valve in combination with hypertrophic cardiomyopathy

A female octogenarian with no prior cardiac history was referred for stress echocardiography to evaluate exertional breathlessness. Resting images revealed asymmetrical septal hypertrophy and direct papillary muscle continuation into the presumed anterior mitral leaflet (top row, centre image). Subvalvular systolic anterior motion, significant left ventricular outflow tract obstruction, and moderate mitral incompetence were noted (see Supplementary material online, Video S1 ). The mitral valve demonstrated …