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Posterior Mitral Leaflet Left Atrial Anomalous Chord in the Absence of Surgical Mitral Regurgitation

Aberrant left atrial (LA) mitral valve chords are rare causes of mitral regurgitation (MR). An aberrant chord on the posterior mitral valve leaflet (PMVL) has not been reported. Transesophageal echocardiogram demonstrated a chord-like structure from the LA to the middle (P2) scallop of the PMVL, causing focal P2 prolapse without typical myxomatous degeneration (movie clip S1). Three-dimensional images revealed that this chord terminated onto a papillary muscle-like structure at the LA (Fig. 1). There was only mild MR. Focal mitral leaflet prolapse without typical myxomatous change may herald the presence of an aberrant chord. Early recognition may alter surveillance needs.