The Heart Condition
Mary Bridge Children's Hospital, Tacoma, WA; 20 Dec. 1996 at 11:30 am -- Dr. Michael Portman

This is a rudimentary description of my understanding of Emma's heart conditions. There are probably some errors here, but you'll get the idea I hope.

Figure 1 - Mitral Valve Cleft

Emma's heart actually had two holes in it that don't belong. The first was a mitral valve cleft and the second was an atrial-septum defect. A mitral valve cleft is a hole in the valve between the left auricle and left ventricle. During "Diastole," the heart relaxes so blood can be drawn into the heart's auricles from the veins leading from the lungs and the body to the heart. When the auricles are full, the tricuspid valve and the mitral valve open. When blood is flowing from the left auricle through the mitral valve into the left ventricle, the normal pressure build up in the ventricle was forcing blood through the hole back into the auricle. The hole in the valve is shown with the black arrow in Figure 1.

Figure 2 - Diastole Phase

During the "Systole" phase, the heart contracts to push blood from the ventricles through the aortic valve into the chambers that push the oxygen-poor blood to the lungs and the oxygen-rich blood to the body. Figure 2 shows the atrial-septum defect with a black arrow and Figure 3 shows the Systole phase.

As you can see, Emma's heart was having blood forced into the left auricle from three sources (the vein, the hole in the mitral valve, and the hole in the septum between the auricle and the path to the artery) instead of one source - the vein.

Figure 3 - Systole Phase

Figure 2 should actually show the mitral valve defect because blood is forced back into the left auricle during the Diastole phase. Figure 3 should show the atrial-septum defect because blood is also forced into the left auricle during the Systole phase. Emma's poor left auricle never empties out.

Additionally, the left auricle is enlarged with excess amounts of blood - which is the ultimate reason for the surgery.