Repair of Mitral Incompetence Secondary to Ruptured Chordae Tendineae

Abstract

Twenty-two patients with ruptured chordae tendineae are presented. Etiology was rheumatic heart disease in seven patients, bacterial endocarditis in four patients, both rheumatic heart disease and endocarditis in two patients, trauma in one patient, and aortic regurgitation in one patient. Exact cause of rupture was unknown in seven patients. Plastic repair of the leaflet and/or posteromedial annuloplasty was done in all the patients. In two patients the annuloplasty broke down soon after the operation and necessitated valve replacement. There was one hospital death. One patient died two years after operation probably because of cerebral embolism; a large thrombus was found in the left atrium at autopsy. All survivors have been followed for 7 months to 8 years and, except for two, are either working full-time or leading an active life. In ruptured chordae early and five-year results after repair of the leaflet and/or posteromedial annuloplasty are very good irrespective of the left atrial enlargement and "V" wave size. Results were better in the rheumatic group than in the nonrheumatic group. In our opinion this method of treatment is superior to prosthetic valve replacement for this condition, except if the annulus is thin and attenuated.