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[Acute mitral valve insufficiency caused by chordae rupture]
Toshinobu Kazui1, Kohei Kawazoe
1Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, Morioka, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|September 15, 2004
Summary
Mitral valve chordae rupture causes acute mitral regurgitation. Surgical repair is a reliable and preferred treatment, offering excellent outcomes and preserving heart function.
Area of Science:
- Cardiovascular Surgery
- Cardiac Pathology
- Medical Diagnostics
Context:
- Mitral valve chordae rupture, often due to myxomatous valve disease or infective endocarditis, leads to acute mitral regurgitation.
- Severe symptoms like dyspnea and shock necessitate prompt diagnosis and intervention.
Purpose:
- To evaluate the efficacy of surgical repair versus replacement for acute mitral regurgitation caused by chordae rupture.
- To highlight mitral valve repair as the primary surgical strategy.
Summary:
- Diagnosis involves clinical assessment, chest X-ray, and echocardiography, with echocardiography crucial for lesion evaluation.
- Initial management focuses on hemodynamic stabilization using inotropic agents, dilators, and intra-aortic balloon pumping (IABP).
- Surgical correction is considered for unstable patients, with mitral valve repair (e.g., quadrangular resection, annuloplasty, artificial chordae) favored over replacement for preserving left ventricular function and avoiding anticoagulation.
Impact:
- A study of 12 patients showed successful mitral valve repair in 9, with significant reduction in mitral regurgitation grade (preoperative 4.0 to postoperative 0.2).
- Mean follow-up of 3.8 years revealed no cardiac events or reoperations, indicating the reliability of repair techniques even with multiple lesions.
- Mitral valve repair is demonstrated as a highly reliable and effective first-choice treatment for acute mitral regurgitation secondary to chordae rupture.