Differentiating Features of Chordal Rupture Associated with Rheumatic Mitral Valve Disease and Primary Mitral Valve Prolapse

It has been known that chordal rupture (CR) is the most important complication of primary mitral valve prolapse (MVP). However, CR may also occur in relation to rheumatic mitral valve disease (RMVD). Although the relationship between MVP and CR has been thoroughly investigated, there is still insufficient information about the formatian of CR in RMVD. The aim of our study was to evaluate the incidence and the differentiating features of patients with CR in both groups as assessed by transesophageal echocardiography (TEE). One-hundred nineteen patients with RMVD (70 male and 49 female, mean age 45), and 60 with MVP (34 male and 26 female, mean age 46) with MR (>2) were included in the study, and were compared with 20 healthy subjects. Both groups were divided into two subgroups with and without CR, and were compared according to age, gender, anterelateral (AL) and postemmedial (PM) chordal length, and mitral valve leaflet related to CR. The incidence of CR was 13 % in RMVD and 25 % in MVP group (p<0.05). There was no significant difference related to age (45 and 43) and gender (male/female: 0.8 and 0.8) between the CR (+)and CR (-) groups of RMVD. Although, male gender was predominant (male/female 4 and 1.9, p<0.05), the older age (58 and 41) was not significant in patients with MVP with CR, in contrary to without CR. On the other hand, there was no significant difference between CR(+) and CR(-) groups with RMVD according to AL (1.63 ± 0.4 and 1.31 ± 0.4 cm) and PM (1.62±0.4 and 1.25 ± 0.4 cm) (p>0.05). Chordal length in MVP group (AL 2.69 ± 0.6, PM 2.78 ± 0.6 cm) was significantly longer than RMVD group (AL 1.53 ± O 6, PM 1.51 ± 0.5 cm) and control group (AL 1.81 ± 0.2, PM 1.80 ± 0.2 cm) (p0.05). But chordal length was not significantly different in CR (+)and CR(-) MVP subgroups (AL 2.75 ± 0.5 and 2.61 0.5, PM 2.77 ± 0.5 and 2.59 ± 0.5 cm) (p>0.05). In rheumatic group incidence of CR associated with anterior and posterior leaflet were 87 % and 13 % respectively. The incidence of CR associated with posterior and anterior leaflet were 80% and 20%, respectively in MVP group (p<0.05) In conclusion, CR assessed by TEE was seen mostly in males and in older age group, and related with posterior leaflet in patients with MVP. However, rheumatic CR involved mostly the anterior leaflet and was not associated with age and gender.