A diastolic mid-echo in torn chordae tendineae of the mitral valve

Echocardiographic studies were performed on 3 patients with torn chordae tendineae of the mitral valve proven by open heart surgery or during autopsy. Mitral regurgitation was noted after episodes of bacterial endocarditis in 3 patients; one had had rheumatic valvular disease before the episode. Conventional M-mode echocardiograms showed coarse diastolic fluttering of the mitral valve, multiple mitral valve echoes in systole, and diastolic mid-echoes between both anterior and posterior leaflets. The last pattern was found in all 3 patients. There was only one patient with an unusual systolic echo in the left atrium. Two-dimensional echocardiograms from 2 patients revealed an abnormal echo in the left ventricle in diastole which moved into the left atrium in systole, slightly beyond the closure line of the mitral valve. This moving abnormal echo observed in two-dimensional echograms presumably originated from torn chordae tendineae and was consistent with the diastolic mid-echo noted in M-mode echograms. Thus, the diastolic mid-echo of the mitral valve by M-mode echocardiography is an important finding in the diagnosis of torn chordae tendineae of the mitral valve, and two-dimensional echocardiography can identify the movement of torn chorda itself.