Prolapse of the Posterior Mitral Leaflet and Mitral Insufficiency Due to Rupture of the Chordae Tendineae

Year 1970, Volume: 23 Issue: 4, 1143 - 1155, 31.08.1970

Sabahattin Kaymakçalan

Abstract

Öncelikle idiopatik hipertrofik subaortik stenoz düşünülen, namun tipik ejeksiyon üfürümü ve klikle başlayan 3/6 derecelik sistolik üfürüm nedeniyle dört yıldır izlenen 42 yaşındaki erkek hastada, kalp yetmezliği bulguları artınca yapılan sol ventrikül anjiografisinde ağır mitral yetmezlik saptandı. Ameliyatta mitral kapağın arka yaprağı anormal büyüklükte, sol atriuma prolapsus halinde bulundu; bu yaprağa bağlı iki kordae tendineae kopmuştu. Kapağın fibrotik yüzeyleri dışında sehih patoloji yoktu. Mitral valv refleks kardiyoplasti ile çıkarılıp Cross-Jones protez mitral kapak takıldı. Postoperatif dönemde kalp boyutları normale döndü, klik ve sistolik üfürüm kayboldu. Arka yaprak prolapsusu ve kordal rüptürün hızlı ilerleyen, cerrahi gerektiren mitral yetmezlik tablosu oluşturabileceğini göstermektedir.

Mitral Kapağının Arka Yaprağının Prolapsusu ve Corda Tendineae Kopmasına Bağlı Mitral Yetmezliği

Abstract

An atypical auscultatory finding—a holosystolic murmur beginning with a midsystolic click—prompted initial misdiagnosis of idiopathic hypertrophic subaortic stenosis in a 42-year-old man. Four years later, he developed progressive left and right heart failure. Left ventricular angiography revealed severe mitral regurgitation. At surgery, the mitral valve’s posterior leaflet was markedly enlarged and prolapsing into the left atrium; two ruptured chordae tendineae tethered the leaflet to the papillary muscles. The leaflets’ surfaces were otherwise unremarkable. The valve was excised and replaced with a cross-Jones prosthesis. Postoperative follow-up showed normalization of cardiac size, resolution of the click, and disappearance of the systolic murmur, confirming that posterior leaflet prolapse with chordal rupture can mimic other left-sided obstructions and may progress rapidly without surgical intervention.

Keywords

cross-Jones prosthesis , chordae tendineae rupture , mitral valve prolapse

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