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Purpose: Aortic coarctation (CoA) is a typical left-sided obstructive lesion. Mitral valve pathology has only been described in the context of Shone'scomplex, a severe type of congenital left-sided obstructive lesion of multiple cardiovascular levels, including CoA. However, the prevalence of mitral valve pathology in adults after coarctation repair has never been evaluated. The aim of this study was to describe the mitral valve apparatus in consecutive CoA patients after repair.Methods: Echocardiograms of 58 consecutive adults after coarctation repair were retrospectively analyzed. The presence of mitral valve stenosis (MS) (gradient > 5 mmHg) and or mitral valve insufficiency (MI) was determined. The mitral valve annulus was evaluated in end diastole and end systole, in the parasternal long axis-, short axis-, and apical four- and two-chamber views. Mitral valve parameters were compared with normal values as described in the literature. Additionally the aortic valve morphology was determined.Results: Fifty-eight adult patients (mean age 35.7 years, range18-82 years; male 61%) were included. Thirty-six patients (62%) had BAV. Mitral valve prolaps was found in 2 patients, double orifice mitral valve in 2 patients. MS was found in 3 patients (all BAV patients). Moderate to severe MI was found in 29 (50%) patients. An increased pressure half time was found in 8 (14%)patients (7 BAV patients). Patients with an increased PHT demonstrated a significantly shorter end systolic annulus length in the 4 chamber view. Of all patients without MI and MS, 6 (10%) patients (5 BAV patients) demonstrated a peak E wave > 105 mm/s and 3 patients a peak A wave > 82 mm/s. Patients with an increased peak E wave had a significantly shorter end systolic-, and end diastolic mitral valve annulus length in the parasternal long axis view as compared to patients with a normal peak E wave. (P=0.008 vs P=0.03). Of the patients without MI and MS, 13 patients (45%) showed a shorter end- systolic and end-diastolic mitral valve annulus length as compared to literature reference values.Conclusion: These findings provide new insights into the mitral valve apparatus in adults after CoA repair, and demonstrate that mitral valve abnormalities are present even in CoA patients without MI or a significant gradient. These findings might suggest that mitral valve abnormalities have a developmental origin in these patients.