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High Prevalence of Unrecognized Chordae Tendineae Rupture in Mitral Valve Prolapse Patients Undergoing Valve Replacement Surgery

Authors
 Hee Tae Yu  ;  Jeonggeun Moon  ;  Woo-In Yang  ;  Chi Young Shim  ;  Sak Lee  ;  Byung-Chul Chang  ;  Geu-Ru Hong  ;  Jong-Won Ha 
Citation
 CANADIAN JOURNAL OF CARDIOLOGY, Vol.29(12) : 1643-1648, 2013 
Journal Title
 CANADIAN JOURNAL OF CARDIOLOGY 
ISSN
 0828-282X 
Issue Date
2013
MeSH
Adult ; Aged ; Chordae Tendineae* ; Comorbidity ; Cross-Sectional Studies ; Delayed Diagnosis/statistics & numerical data* ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Valve Diseases/diagnosis ; Heart Valve Diseases/epidemiology* ; Heart Valve Diseases/surgery* ; Heart Valve Prosthesis Implantation* ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnosis ; Mitral Valve Insufficiency/epidemiology* ; Mitral Valve Insufficiency/surgery* ; Mitral Valve Prolapse/diagnosis ; Mitral Valve Prolapse/epidemiology* ; Mitral Valve Prolapse/surgery* ; Republic of Korea ; Rupture, Spontaneous
Keywords
Adult ; Aged ; Chordae Tendineae* ; Comorbidity ; Cross-Sectional Studies ; Delayed Diagnosis/statistics & numerical data* ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Valve Diseases/diagnosis ; Heart Valve Diseases/epidemiology* ; Heart Valve Diseases/surgery* ; Heart Valve Prosthesis Implantation* ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency/diagnosis ; Mitral Valve Insufficiency/epidemiology* ; Mitral Valve Insufficiency/surgery* ; Mitral Valve Prolapse/diagnosis ; Mitral Valve Prolapse/epidemiology* ; Mitral Valve Prolapse/surgery* ; Republic of Korea ; Rupture, Spontaneous
Abstract
BACKGROUND: Not infrequently, chordae tendineae rupture, which was not recognized preoperatively using echocardiography, was found during mitral valve (MV) surgery in patients with severe mitral regurgitation (MR) diagnosed with MV prolapse. We evaluated the incidence and predictors of echocardiographically-unrecognized chordae tendineae rupture in patients with severe MR because of MV prolapse. METHODS: We enrolled 124 patients undergoing MV surgery for severe MR because of nonrheumatic MV prolapse. Patients with MR because of infective endocarditis, ischemic heart disease, or echocardiographically-detected chordal rupture were excluded. The study sample was divided into 2 groups: surgically-proven chordae tendineae rupture (n = 51), and no chordae rupture (n = 73). RESULTS: Echocardiographically-unrecognized chordae tendineae rupture was found in 51 (41%) of 124 patients undergoing MV surgery because of MR. It was more common in patients with posterior or single-leaflet prolapse. Although the severity of MR was greater in patients with chordal rupture, left atrial volume index was smaller compared with those without. In a multivariate analysis, involvement of posterior leaflet (odds ratio [OR], 2.80; 95% confidence interval [CI], 1.15-6.84) or single leaflet (OR, 3.18; 95% CI, 1.07-9.45), MR severity (OR, 4.76; 95% CI, 1.96-11.59), and left atrial volume index (OR, 0.98; 95% CI, 0.96-0.99) were independently associated with chordal rupture (P < 0.05 for all). CONCLUSIONS: Unrecognized chordae tendineae rupture is a common unrecognized contributor to severe MR necessitating valve replacement in MV prolapse patients. Earlier recognition and more specific management might contribute to improved prognosis for such patients.
Full Text
http://www.sciencedirect.com/science/article/pii/S0828282X13013962
DOI
10.1016/j.cjca.2013.09.002
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Chang, Byung Chul(장병철)
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88422
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