The Clinical Diagnosis and Surgical Management of Ruptured Mitral Chordae Tendineae

Six patients with mitral insufficiency secondary to ruptured chordae tendineae are presented. Each patient underwent surgical correction of the deformed valve. In two instances the posterior leaflet was involved while in four the anterior leaflet was affected. Three patients had definite bacterial endocarditis that appeared to be related to the onset of cardiac symptoms. In the two instances of posterior valve involvement there were an aortic thrill and a harsh systolic murmur, whereas in two of the four with rupture of the anterior leaflet an aortic systolic murmur was heard but no thrill was felt. The other two with anterior leaflet disease disclosed no murmurs in the aortic area. These findings are considered to be a result of the direction of the regurgitant jet and the area in which they strike the left atrium. None of the patients had hemodynamic evidence of aortic valve disease and in each instance the aortic systolic murmur decreased or disappeared after surgery. Each patient had gross left atrial enlargement. Although relatively uncommon, mitral insufficiency due to rupture of the mitral chordae tendineae is readily corrected surgically.