High prevalence of unrecognized chordae tendineae rupture in mitral valve prolapse patients undergoing valve replacement surgery

Hee Tae Yu, Jeonggeun Moon, Woo In Yang, Chi Young Shim, Sak Lee, Byung Chul Chang, Geu Ru Hong, Jong Won Ha

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1643-1648
Number of pages6
JournalCanadian Journal of Cardiology
Volume29
Issue number12
DOIs
Publication statusPublished - 2013 Dec 1

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Chordae Tendineae
Mitral Valve Prolapse
Mitral Valve Insufficiency
Rupture
Odds Ratio
Mitral Valve
Confidence Intervals
Prolapse
Endocarditis
Myocardial Ischemia
Echocardiography
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Yu, Hee Tae ; Moon, Jeonggeun ; Yang, Woo In ; Shim, Chi Young ; Lee, Sak ; Chang, Byung Chul ; Hong, Geu Ru ; Ha, Jong Won. / High prevalence of unrecognized chordae tendineae rupture in mitral valve prolapse patients undergoing valve replacement surgery. In: Canadian Journal of Cardiology. 2013 ; Vol. 29, No. 12. pp. 1643-1648.
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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.",
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High prevalence of unrecognized chordae tendineae rupture in mitral valve prolapse patients undergoing valve replacement surgery. / Yu, Hee Tae; Moon, Jeonggeun; Yang, Woo In; Shim, Chi Young; Lee, Sak; Chang, Byung Chul; Hong, Geu Ru; Ha, Jong Won.

In: Canadian Journal of Cardiology, Vol. 29, No. 12, 01.12.2013, p. 1643-1648.

Research output: Contribution to journalArticle

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T1 - High prevalence of unrecognized chordae tendineae rupture in mitral valve prolapse patients undergoing valve replacement surgery

AU - Yu, Hee Tae

AU - Moon, Jeonggeun

AU - Yang, Woo In

AU - Shim, Chi Young

AU - Lee, Sak

AU - Chang, Byung Chul

AU - Hong, Geu Ru

AU - Ha, Jong Won

PY - 2013/12/1

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N2 - 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.

AB - 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.

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