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Abstract

Ruptured mitral chordae tendinae is a classical complication of myxomatous mitral valves or Barlow's syndrome. This complication is controversial in non-myxomatous mitral valve. Of 91 consecutive patients with mitral valve prolapse examined over an 18 months period by transthoracic and transesophageal echocardiography, 42 (18 women and 24 men) with an average age of 76 ± 8 years (60-93 years) had ruptured mitral chordae tendinae. The thickness of the anterior mitral leaflet measured at the distal third of the valve by transesophageal echocardiography enabled the identification of two groups of patients; group I: > 3 mm (24 patients), average 4.8 ± 0.8 mm and group II: ≤ 3 mm (18 patients), average 2.6 ± 0.3 mm. The diameter of the mitral ring and left atrium, the length of the anterior mitral leaflet, the left ventricular end diastolic dimensions and fractional shortening, were measured by transthoracic 2D echocardiography (mitral ring) and M mode (other parameters). Ruptured chordae were detected in only 13 cases (31%) by transthoracic echocardiography; 38% were asymptomatic and a chance finding at transesophageal echocardiography. No significant difference was observed between the two groups with respect to age, gender presence of hypertension, dimensions of the cardiac chambers, fractional shortening or localisation of the prolapse related to the ruptured chordae. Fifty-eight per cent of patients in group I were in NYHA functional classes 3-4 as compared to 16% in group II (p < 0.02). The size of the left atrium was significantly greater in group I, 51 ± 8 mm vs 38 ± 7 mm (p < 0.001). Two-dimensional color Doppler enabled differentiation between moderate and significant mitral regurgitation. Significant mitral regurgitation was more common in group I (p < 0.02). Therefore, ruptured chordae tendinae is common in non-myxomatous mitral valve in the elderly, usually as an asymptomatic finding. Transesophageal echocardiography is the diagnostic method of reference. The NYHA functional class, left atrial and mitral ring dilatation, are associated with mitral regurgitation of greater severity and are more common in chronic mitral regurgitation in myxomatous valves.