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Gaping cleft or commissure--an under-rated cause of residual mitral insufficiency following valve repair: case reports.

Naturally occurring clefts in the posterior leaflet of the mitral valve and/or the mitral commissures themselves may become the foci of residual mitral regurgitation when distorted by an adjacent rigid suture line. Herein are reported the details of three cases in which cleft/commissure closure resolved such leaks. The anatomical substrate which predisposed to this problem is also discussed.