Korean Circ J.  2009 Jul;39(7):292-294. 10.4070/kcj.2009.39.7.292.

Acute Mitral Regurgitation due to Spontaneous Chordal Rupture in a Patient With Obstructive Hypertrophic Cardiomyopathy

• Yang MJ
• Kang SJ
• Yoon MH
• Hwang YH
• Lim HS
• Choi BJ
• Choi SY
• Hwang GS
• Shin JH
• Hong YS
• Tahk SJ

• KMID: 2145566
• DOI: http://doi.org/10.4070/kcj.2009.39.7.292

Abstract

A 69-year-old male presented with obstructive hypertrophic cardiomyopathy, mitral valve regurgitation, and myxomatous mitral valve prolapse. A spontaneous chordal rupture and acute severe mitral regurgitation resulted in abrupt clinical deterioration despite complete relief of severe left ventricular outflow tract obstruction and systolic anterior motion of the anterior mitral leaflet. The patient underwent extensive cardiac surgery due to intractable heart failure. Surgical procedures included a mitral valve replacement, a septal myectomy, and the Maze procedure.

Keyword

Hypertrophic cardiomyopathy; Chordae tendineae; Mitral valve regurgitation

MeSH Terms

Aged
Cardiomyopathy, Hypertrophic
Chordae Tendineae
Heart Failure
Humans
Male
Mitral Valve
Mitral Valve Insufficiency
Mitral Valve Prolapse
Rupture
Thoracic Surgery

Figure

• 

  Fig. 1 Doppler echocardiographic findings. A: the peak velocity of the left ventricular outflow tract was 4.6 m/s on initial Doppler examination, and the peak pressure gradient was 85 mm Hg. B: follow-up Doppler echocardiography demonstrated remarkable reductions in left ventricular outflow tract velocities and pressure gradients (peak velocity of left ventricular outflow tract was 1.75 m/s and the peak pressure gradient was 12 mmHg).

• 

  Fig. 2 Transesophageal echocardiography. A: the medial segments of both leaflets (P3 and A3 segments) revealed flail motion and ruptured chordae (red arrow). B: severe mitral regurgitation was detected on color Doppler echocardiography.

• 

  Fig. 3 Intraoperative findings. Ruptured chordae (black arrows) were attached to the middle segment of the anterior mitral valve leaflet (A2) and the posteromedial commissure.

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