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Massive mitral regrgitation from chordal rupture and coronary artery disease
Insights
Spontaneous chordae tendineae rupture can occur in patients with coronary artery disease. This study highlights six cases requiring simultaneous mitral valve replacement and coronary revascularization.
Area of Science:
- Cardiovascular Surgery
- Cardiac Pathology
Background:
- The etiology of spontaneous chordae tendineae rupture is not fully understood.
- Previous reports have not identified coronary artery occlusion as a sole or primary condition associated with chordal rupture.
Observation:
- Six cases of chordal rupture were identified in 600 patients undergoing mitral regurgitation surgery over six years.
- All identified patients had underlying or associated coronary artery occlusion.
Findings:
- Spontaneous chordae tendineae rupture occurred in patients with coronary artery disease.
- All six patients required and underwent simultaneous mitral valve replacement and coronary revascularization.
Implications:
- Coronary artery disease should be considered in the differential diagnosis of spontaneous chordae tendineae rupture.
- Simultaneous surgical intervention for mitral valve and coronary artery disease may be necessary in affected patients.
Abstract:
The precise mechanism that causes spontaneous rupture of chordae tendineae remains unknown. That it may occur in patients with no disease other than underlying or associated coronary artery occlusion has not been previously reported. Six patients with chordal rupture were found among 600 patients who underwent operation for mitral regurgitation in a 6-year period. All 6 patients without exception underwent simultaneous mitral valve replacement and coronary revascularization. The salient clinical features of these patients are summarized, and 1 case is reported in detail.