[Acute mitral valve insufficiency caused by chordae rupture].
The common causes of mitral valve chordae rupture are myxomatous valve disease, infective endocarditis. Acute mitral valve insufficiency from chordae rupture, severe clinical symptoms such as dyspnea and shock are observed. Diagnosis is made with clinical symptoms, chest X-ray and echocardiography. Echocardiography is very useful to evaluate the exact lesions. First, inotropic agents, dilators and intraaortic balloon pumping (IABP) are used to stabilize hemodynamic status. Once hemodynamic status becomes unstable in spite of such therapy, surgical correction of mitral regurgitation (MR) is considered. Mitral valve repair should be the first choice of surgical repair, because it preserves left ventricular function, avoids anti-coagulation therapy. Quadrangular resection and suture, annuloplasty and artificial chordae are reliable surgical techniques. If mitral valve repair is difficult, mitral valve replacement is another option. From 1994 to 2002, there were 12 patients who underwent emergency mitral valve surgery because of chordae rupture. There were 7 men and 5 women with mean age of 52.7+/-14.3 years old. Nine of them received mitral valve repair. Two patients were infective endocarditis. Preoperative MR grade was 4.0+/-0.0. Postoperative MR grade was 0.2+/-0.2. Mean follow-up period was 3.8 years. There were no cardiac events and reoperations. Repair technique is quite reliable even in patients with multiple lesions, and the surgical results were almost same as single lesion patients. Repair technique should be the first choice to treat acute MR caused by chordae rupture.
Kazui
Toshinobu
T
Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, Morioka, Japan.
Kawazoe
Kohei
K
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002815:Chordae Tendineae; D005260:Female; D006341:Heart Rupture / Q000150:complications* / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000601:surgery; D013536:Suture Techniques