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Optimal Management of Mitral Regurgitation Due to Ruptured Mitral Chordae Tendineae in Patients With Hypertrophic

Eglal A Ahmed1, Hartzell V Schaff1, Jeffrey B Geske2

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.

Seminars in Thoracic and Cardiovascular Surgery
|May 22, 2022
PubMed

Insights

Mitral valve repair during septal myectomy is a safe treatment for hypertrophic cardiomyopathy patients with mitral regurgitation from ruptured chordae, showing good long-term survival.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Research

Background:

  • Hypertrophic cardiomyopathy (HCM) often presents with mitral valve disease, leading to controversy in surgical management.
  • Left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR) are common complications in HCM patients requiring intervention.

Purpose of the Study:

  • To investigate the management and long-term outcomes of surgical intervention for MR caused by ruptured chordae tendineae in HCM patients.
  • To evaluate the safety and efficacy of mitral valve repair versus prosthetic replacement in this patient cohort.

Main Methods:

  • Retrospective analysis of 49 consecutive HCM patients with MR due to ruptured chordae tendineae.
  • Review of echocardiograms and operative reports to classify valve anatomy and surgical techniques.
  • Assessment of late outcomes via electronic medical records and follow-up surveys, including survival rates and reoperation data.

Main Results:

  • 46 out of 49 patients had significant LVOT obstruction at surgery.
  • Mitral valve repair was performed in 45 patients; prosthetic replacement was needed in 4.
  • Concomitant septal myectomy was performed in 46 patients, with no hospital or 30-day mortality.
  • Five and ten-year survival rates were 92% and 71%, respectively.
  • Three patients required reoperation for mitral valve replacement at varying intervals after initial repair.

Conclusions:

  • Ruptured mitral chordae can cause severe MR in HCM patients.
  • Mitral valve repair (valvuloplasty) during septal myectomy is a safe and effective procedure for HCM with MR.
  • This approach offers an acceptably low rate of recurrent MR necessitating prosthetic valve replacement.

Keywords:
HCM (hypertrophic cardiomyopathy)LVOT (left ventricular outflow tract)MR (mitral regurgitation)MVR (Mitral valve replacement)

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