Chordae Rupture and Acute Mitral Regurgitation Associated with Infective Endocarditis in a Patient Undergoing Hemodialysis / 대한내과학회지

Acute pulmonary edema in patients undergoing hemodialysis is a common cause of hospital admission and is often associated with fluid overload or congestive heart failure. Here, we report a rare case of chordae rupture and consequent severe mitral valve regurgitation due to infective endocarditis presenting as sudden onset pulmonary edema after properly conducted hemodialysis.

Tricuspid Valve Repair for Traumatic Tricuspid Valve Regurgitation over 30 Years after Causative Trauma / 日本心臓血管外科学会雑誌

A 28-year-old man was involved in a traffic accident that sandwiched his chest between a wall and a truck. Shortness of breath and other symptoms started to appear several years later. Echocardiography at that time showed severe tricuspid regurgitation due to a failed valve and ruptured chordae in the anterior leaflet. He was followed up with medication. Leg edema developed at the age of 62 years and worsening symptoms of heart failure over a period of 6 months indicated a need for surgery. Intraoperative findings revealed the ruptured chordae attached to the anterior leaflet and a scarred myocardium at the septomarginal trabeculation. The tricuspid valve was surgically repaired, the anterior leaflet chordae were surgically reconstructed, an annuloplasty ring was implanted to address the tricuspid regurgitation and atrial fibrillation was treated using the Maze procedure. Surgery 34 years after trauma has improved hemodynamic cardiac function and normalized the cardiac rhythm in this patient.

Clinical Characteristics of Surgically Corrected Mitral Regurgitation Due to Myxomatous Degeneration in Korea

BACKGROUND AND OBJECTIVES: Although the clinical significance of mitral regurgitation (MR) due to prolapse or chordae rupture with myxomatous degeneration (MD) is increasing significantly, clinical features of patients with MD in Korea are not characterized. MATERIALS AND METHODS: Retrospective analysis of clinical data of 90 patients who underwent surgical correction of significant MR due to MD was performed. Lesion sites of MD were confirmed during surgery; anterior (A) and posterior (P) mitral leaflets were divided into lateral (A1 & P1), middle (A2 & P2), and medial segments (A3 & P3). METHODS: Mean age was 5114 years and male / female ratio was 1; age distribution showed typical bimodal pattern with two peaks at the mid-thirties and the mid-fifties each. MD was confined to P leaflet in 36 (40%), A leaflet in 20 (22%), and both leaflets in 34 patients (38%). Forty-six patients (51%) showed MD in a single segment, and 37 (41%) in 2 segments; 7 patients (8%) showed MD in more than 2 segments. In 90 patients, pathologic MD was confirmed in 139 mitral segments; among them, P3 was the most commonly involved segment (30%), followed by A3 (17%), P2 (14%), A2 (14%), A1 (14%), and P1 (12%). Hypertension (HT) was more frequently observed in female patients (42%) than in male patients (16%) (p<0.05). Chordae rupture was observed in 71 patients (79%), which was associated with HT. Younger patients (age<45 years, N=31) showed lower prevalence of HT and higher incidence of MD involving multiple segments. Valve repair was successful in 83 patients (92%), which was not associated with lesion sites or numbers of MD. Three-year event free survival rate was 865% and independent on sites and numbers of MD. CONCLUSION: MD develops preferentially in the medial part of the mitral valve, and patterns of clinical presentation can change according to the age and existence of HT in these selected patients with significant MR. However, the morphologic characteristics of MD do not seem to affect the feasibility of repair and long-term prognosis.

Tricuspid Regurgitation Due to Rupture of a Chordae in Newborn: A Report of One Cases / 대한흉부외과학회지

Tricuspid regurgitation due to rupture of a chorda is a rare disease in newborns. Recently, we experienced one day old male with tricuspid regurgitation due to rupture of a chorda of anterior papillary muscle, and who had suffered from severe hypoxemia, acidosis, cyanosis, and bradycardia. Preoperative diagnosis was pulmonary atresia with intact ventricular septum, massive tricuspid regurgitation, and patent ductus arteriosus by echocardiogram, which demonstrated no flow through the pulmonic valve. At operation, the pulmonic valve was intact and a chorda of anterior papillary muscle was ruptured. Tricuspid regurgitation was corrected successfully with reconstruction of the chorda. Postoperative course was complicated by pneumonia and sepsis, but the infant recovered and discharged at postoperative 20 days.