Mitral Insufficiency Secondary to Ruptured Chordae Tendineae

Abstract

Mitral insufficiency secondary to ruptured chordae tendineae of the mitral valve is a relatively rare clinical entity. Generally, 4 mechanisms have been suggested previously to which rupture of the chordae in patients can be attributed: spontaneous rupture; rupture of previously diseased chordae during or after physical exertion; rupture of normal chordae due to severe thoracic trauma; and rupture due to bacterial endocarditis engrafted upon chordae and valves previously deformed. In addition, in 1 patient the deranged functional anatomy of muscular subvalvular aortic stenosis is though to be related to the chordae rupture. The syndrome is characterized by unusual manifestations of mitral insufficiency. In 2 patients the physical findings simulated aortic stenosis, and the latter diagnosis had to be excluded by cardiac catheterization and cineangiocardiography. In two others the cineangio-cardiograms revealed the hooded deformity of the mitral leaflet. In all, the electrocardiogram revealed U wave abnormalities. In 2, these developed de novo from the presumed time of chordae rupture and in the remaining 2, the time of the first appearance of this electrical abnormality was unknown.