CHORDAE TENDINeAE RUPTURE
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Transcript of CHORDAE TENDINeAE RUPTURE
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AM ReportTJ O’Neill 3/24/10
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Cardiogenic Shock w/ Preserved EFWith pulmonary edema Acute severe aortic regurgitation Acute severe mitral regurgitation
Without pulmonary edema Cardiac Tamponade Acute massive PE Acute RV infarction
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Chordae Rupture First described in 1806 Most commonly “primary”, highest association
w/ rheumatic fever, infectious endocarditis Also MVP, collagen vasc disease, trauma,
hypertrophic, but also longstanding hypertension
Chordae classified based on site of insertion
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Chordae Rupture
6.6–8.1% of all valvular surgeries, 9.3–20% of all mitral valve surgeries 26% among emergency mitral regurgitation
surgeries P2, P3, or P 2-3 are most likely to flail
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Chordal RuptureDiagnosis
Rapid clinical deterioration is frequent w/ associated dyspnea, tachypnea, pulmonary edema
Chordal rupture will usually have associated gallop S3 and S4 w/ hyperactive prechordium and possible thrill
Murmur may radiate upward, posterior as well as apical and compared to chronic MR is early to mid- peaking due to lack of a compliant atrium
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Chordal RuptureDiagnosis
Flail mitral leaflet
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Chordal RuptureDiagnosis
Because regurgitant jet is asymmetric, pulmonary edema can occur unilaterally
NEJM 361:e6. July 30th 2009, 5.
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Acute Mitral RegurgitationTreatment
Afterload reduction if BP tolerates ACE-I, Hydralazine, Sodium nitroprusside Diuretics
Intra-aortic balloon pump
CT surgery consult for any symptomatic patients as mortality is much higher than chronic MR
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References
Br Heart J. 1983 October; 50(4): 312–317 Gabbay U, Yosefy C.,Int J Cardiol. 2010 Mar 6. Heart 2009 Jun; 95 (12): 976-9.
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For Inquiries Regarding the Train Shaped Cupcake Pan, Speak to Jason Haag
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