title: Don't stop at two.
abstract: An asymptomatic 35-year-old woman with history of coarctation repair underwent routine echo. This showed a bicuspid aortic valve with a significant gradient in the left ventricular outflow tract (LVOT). The anterior mitral valve leaflet appeared redundant. Transoesophageal echo showed thickened chordae tendineae from both mitral valve leaflets inserted into a single postero-medial papillary muscle-a parachute mitral valve. During systole, there was anterior motion of redundant mitral chordae into the LVOT producing significant obstruction. A diagnosis of partial Shone complex was made. She was referred for mitral (and possibly aortic) valve surgery. The combination of aortic coarctation with bicuspid aortic valve should stimulate a search for other levels of systemic obstruction-don't stop at two!
authors.affiliation: Cardiac Unit, Altnagelvin Hospital, Western HSC Trust, Glenshane Road, Londonderry, BT47 6SB, UK. john.purvis@btinternet.com
authors.forename: John A
authors.initials: JA
authors.lastname: Purvis
authors.forename: Vincent
authors.initials: V
authors.lastname: Kennedy
authors.forename: Albert J
authors.initials: AJ
authors.lastname: McNeill
mesh_terms: D000015:Abnormalities, Multiple; D000328:Adult; D001017:Aortic Coarctation / Q000150:complications*; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008943:Mitral Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed