Successful Replacement of "parachute" Mitral Valve in a Child.

HE DEFORMITY called "parachute mitral valve" represents a form of congenital mitral stenosis in which the chordae tendineae converge to insert into one papil-lary muscle.' This type of malformation is rare and has been described previously only in association with other anomalies; with corrected transposition of the great vessels;2 as a component of a developmental complex' with other obstructive lesions of the left side of the heart, supravalvular ring of the left atrium, subaortic stenosis and coarctation of the aorta; and in association with a patent ductus arteriosus, coarctation of the aorta, and an anomalous coronary artery.3 It has been pointed out that "mitral com-missurotomy" does not relieve the obstruction in cases of "parachute deformity" of the mitral valve.' It appears pertinent therefore to report a case of isolated congenital mitral stenosis of the so-called "parachute type," in which successful replacement of the valve was accomplished with evident clinical improvement. boy was born of a normal pregnancy and delivery, but at 24 hours of age began to have episodes of cyanosis and respiratory distress. At approximately 132 months of age he developed a chronically recurrent diarrhea. At 6 months of age he was found to have lactose in his urine and his diarrhea subsided with a lactose-free, galactose-free diet. He continued to have episodes of respiratory distress, which were interpreted as pneumonia or bronchitis. In addition, he exhibited easy fatigability and poor growth and development. In view of his peculiar frail habitus with sunken eyes, his chromosome pattern was investigated and a normal karyotype was found. A murmur had been heard since infancy, but was initially interpreted as nonsignificant. Subsequently, it became more prominent and viewed as the systolic murmur of a ventricular septal defect. Roentgeno-grams of the thorax showed a normal cardiac shadow during the first 2 years of life. Subsequently , minimal cardiomegaly appeared, with definite prominence of the left atrium and increased pulmonary vascular markings, which were attributed to a left-to-right shunt. The electrocardiogram was initially within normal limits, but later showed wide notched P waves indicative of left atrial enlargement. At 3 years of age, he continued to show limited exercise tolerance and had difficulty sleeping without elevation of his head by several pillows. Respiratory symptoms persisted, with hypersecretion of mucous, dyspnea, and occasional cyanosis. Fine rales were present on ausculta-tion of the chest. There was a prominent murmur, which was now identified as diastolic in …