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Mitral regurgitation due to ruptured chordae tendineae in patients with hypertrophic obstructive cardiomyopathy

W X Zhu1, J K Oh, S L Kopecky

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

Journal of the American College of Cardiology
|July 1, 1992
PubMed

Insights

Mitral regurgitation in hypertrophic obstructive cardiomyopathy can stem from ruptured chordae tendineae, not just systolic anterior motion. Transesophageal echocardiography aids diagnosis, enabling successful valve repair.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) commonly causes mitral regurgitation (MR) via systolic anterior motion (SAM) of the anterior mitral leaflet.
  • Ruptured chordae tendineae are an less common, yet significant, cause of MR in HOCM patients.

Observation:

  • Five HOCM patients presented with MR due to ruptured chordae tendineae.
  • Diagnosis was confirmed intraoperatively during septal myectomy-myotomy (Morrow procedure).
  • Transesophageal echocardiography (TEE) successfully identified chordal rupture preoperatively in recent cases.

Findings:

  • All five patients underwent successful septal myectomy-myotomy for left ventricular outflow tract obstruction.
  • Mitral valve competence was restored through valve repair, avoiding prosthetic replacement.
  • TEE proved valuable for preoperative diagnosis of chordal rupture.

Implications:

  • Chordal rupture should be considered in the differential diagnosis of MR in HOCM, particularly with acute hemodynamic decline.
  • TEE is a crucial diagnostic tool for identifying chordal rupture in HOCM.
  • Successful management involves septal myectomy-myotomy and mitral valve repair.

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