A rare, congenital, non-syndromic heart malformation characterized by a slit-like hole or defect in one of the mitral valve leaflets, which is usually thickened and distorted. It usually affects the anterior leaflet, but the cleft of posterior leaflet has also been described. Cleft mitral valve can be isolated or associated with other congenital heart anomalies.

Echocardiography is the most useful not invasive technique for cleft diagnosis and to indicate the right surgical correction.

A 41 years old female was admitted with congenital heart disease. At admission the patient was asymptomatic for dyspnea and chest pain. Auscultation showed a holosystolic murmur on the left sternal border. ECG revealed no significant abnormalities.

A previous transthoracic echocardiography (TTE) had revealed an anterior mitral leaflet cleft  with moderate regurgitation (eccentric jet towards left atrium lateral wall), a mild right atrium and right ventricle dilated with Large ASD with left to right shunt and another small ASD with left to right shunt with a conserved systolic function (LVEF 50%), and mild systolic pulmonary artery pressure.

Patient was taken for surgery for INTRA CARDIAC REPAIR, Cleft AML leaflet was repaired and OP ASD Closure done with Pericardial Patch and atrial and ventricular pacing wires were kept in Situ. Patient was discharged on POD 5 and Pacing wires were removed on subsequent follow up.