DOI: 10.1111/j.1540-8175.2009.01096.x C  2010, Wiley Periodicals, Inc. Depicting of a Cleft Mitral Valve by Real Time Three-Dimensional Transesophageal Echocardiography Mehmet ¨ Ozkan, M.D., F.E.S.C., ∗ Hasan Kaya, M.D., ∗ Nil¨ ufer Eks ¸i Duran, M.D., ∗ Murat Biteker, M.D., ∗ Anıl Avcı, M.D., ∗ Mustafa Yıldız, M.D., Ph.D., ∗ and Altu˘ g Tuncer, M.D.† ∗ Department of Cardiology, and †Department of Cardiovascular Surgery, Kosuyolu Kartal Heart Education and Research Hospital, Istanbul, Turkey We report the usefulness of real time three-dimensional transesophageal echocardiography in com- prehensive delineation of cleft mitral valve. This new technique may be a useful supplement to two- dimensional and three-dimensional transthoracic echocardiography in the assessment of this pathology. (Echocardiography 2010;27:356-358) Key words: Three dimensional transesophageal echocardiography, cleft in left atrioventricular valve, atrial septal defect Figure 1. Two-dimensional transeso- phageal echocardiography revealed ostium primum atrial septal defect. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventri- cle; PR ASD = ostium primum atrial septal defect. A 49-year-old-female referred with dysp- nea. Although, two-dimensional transesophageal echocardiography revealed ostium primum atrial septal defect (ASD) (Fig. 1, movie clip 1) and moderate-mitral regurgitation (MR) with a cleft mitral valve, real time three-dimensional Address for correspondence and reprint requests: Hasan Kaya, M.D., Department of Cardiology, Kosuyolu Kartal Heart Edu- cation and Research Hospital, Istanbul, Turkey. Fax: +90 216 4596321; E-mail: dr_hasankaya@yahoo.com transesophageal echocardiography (RT-3D-TEE; Philips iE33, Philips Medical System, Andover, MA, USA) with direct en face visualizing prop- erty, clearly disclosed primum ASD, and a cleft located in the midportion of the anterior leaflet extended toward the leaflet base (Fig. 2, movie clip 2), with three-dimensional (3D) reconstruc- tion of MR (movie clip 3). Intraoperative examination through the transseptal approach confirmed the cleft mitral valve (Fig. 3) and septum primum ASD. The 356