title: Acute congestive heart failure due to ruptured mitral chordae tendineae in late pregnancy.
abstract: A 31-year-old woman complained of dyspnea and orthopnea at 38 weeks of gestation. A grade 3/6 pansystolic murmur was heard, and echocardiography revealed severe mitral regurgitation with a hyperechoic obstacle on the posterior mitral valve leaflet, consistent with a diagnosis of acute heart failure due to a ruptured chordae tendineae or an infectious endocarditis. An emergency cesarean section was performed under general anesthesia. A male infant was born weighing 2928 g with Apgar scores of 7 and 8 at 1 and 5 min, respectively. The patient was managed in the intensive care unit and underwent open-heart surgery for mitral valve repair on postpartum day 3. The two chordal tendineae appeared torn and frail, and a mitral annuloplasty was performed. No finding of infectious endocarditis was observed. Because it is a dramatic and life-threatening clinical situation, proper diagnosis and treatment in the intensive care unit assure a good outcome for both mother and fetus.
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.
authors.forename: Sugiko
authors.initials: S
authors.lastname: Ohishi
authors.forename: Hayase
authors.initials: H
authors.lastname: Nitta
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Chinen
authors.forename: Tadatsugu
authors.initials: T
authors.lastname: Kinjo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masamoto
authors.forename: Kaoru
authors.initials: K
authors.lastname: Sakumoto
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Maeda
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kuniyoshi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Aoki
mesh_terms: D000328:Adult; D002585:Cesarean Section; D002815:Chordae Tendineae; D004632:Emergency Medical Services; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology* / Q000601:surgery; D012422:Rupture, Spontaneous