"Pac-Man Heart" and Mitral Valve Prolapse: An Unreported Liaison

A 50-year-old man accessed the echo laboratory for dyspnea. His medical history was unremarkable. Transthoracic two-dimensional echocardiogram showed a posterior leaflet of the mitral valve prolapse associated with eccentric regurgitant jet. An excavation of the medium interventricular septum, in the absence of left–right interventricular shunt, was detected as an incidental finding and considered as partial ventricular septum defect. Owing to the absence of acute myocardial infarction and thrombolysis in patient's medical history, this finding has been considered “pac-man heart” of the congenital origin. Of note, the association of this deformity with mitral valve prolapse is reported for the first time.