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High prevalence of unrecognized chordae tendineae rupture in mitral valve prolapse patients undergoing valve

Hee Tae Yu1, Jeonggeun Moon, Woo-In Yang

  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

The Canadian Journal of Cardiology
|November 5, 2013
PubMed
Abstract

Insights

Chordae tendineae rupture is often missed before mitral valve surgery in patients with mitral valve prolapse and severe mitral regurgitation. Early detection of this unrecognized chordal rupture could improve patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Imaging
  • Valvular Heart Disease

Background:

  • Chordae tendineae rupture is a frequent, yet often unrecognized, cause of severe mitral regurgitation (MR) in patients with mitral valve (MV) prolapse.
  • Preoperative echocardiography frequently fails to detect chordal rupture, leading to its intraoperative discovery during MV surgery.

Purpose of the Study:

  • To determine the incidence of echocardiographically-unrecognized chordae tendineae rupture in patients undergoing MV surgery for severe MR due to MV prolapse.
  • To identify predictors associated with this unrecognized chordal rupture.

Main Methods:

  • A cohort of 124 patients with severe MR from nonrheumatic MV prolapse undergoing MV surgery were analyzed.
  • Patients with MR due to infective endocarditis, ischemic heart disease, or known chordal rupture were excluded.
  • The cohort was divided into groups with and without surgically confirmed chordae tendineae rupture.

Main Results:

  • Echocardiographically-unrecognized chordae tendineae rupture was identified in 41% of patients (51 out of 124).
  • Posterior leaflet or single-leaflet prolapse, greater MR severity, and smaller left atrial volume index were independently associated with chordal rupture.
  • Posterior leaflet involvement (OR, 2.80), single leaflet involvement (OR, 3.18), MR severity (OR, 4.76), and left atrial volume index (OR, 0.98) were significant predictors.

Conclusions:

  • Unrecognized chordae tendineae rupture is a common finding in severe MR patients with MV prolapse, often necessitating valve replacement.
  • Improved preoperative recognition and tailored management strategies for chordal rupture may enhance patient prognosis.

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