Differentiating Features of Clinical, Echocardio-graphic and Hemodynamic Course in Patients with Chordal Rupture Associated with Rheumatic Mitral Valve Disease and Mitral Valve Prolapse

The purpose of this study is to investigate and to compare elinical and echocardiographic characteristics and hemodynamic consequences secondary to chordal rupture (CR) associated with rheumatic mitral valve disease (RMVD) and primary mitral valve prolapse (MVP). Study group comprised 224 pts (M 118, F 106, mean age 46.3±15.3) with severe mitral regurgitation associated w ith RMVD(n= 141) and with MVP(n=83) evaluated by transthoracic and transesophageal echocardiography. Chordal rupture was detected in 58 (25.9 %) of the pts, ard CR found to be associated with RMVD in 25 pts (M ll, F 14, mean age 44.3±13) and with MVP in 33 pts (M 26, F 7, m ean age 55.4±1 1.4). Mitralleaflet(s) associated with CR, left atrium diameter, mitral regurgitation jet area, mitral annulus circumference, posteromedial and anterolateral chordal length, infective endocarditis, functional class (NYHA), frequency of acute decompensation, estimated pulmonary artery systolic pressure by Doppler, need to mitral valve surgery in the following 3 months in both groups with CR were compared. Chordal rupture was found to be associated with anterior, posterior and both mitral leaflets in 20 (80%), 4 (16%) and 1 (4%) of pts with RMVD, and in 6 (18.2%), 24 (72.7%) and 3(9%) of pts with MVP, respectively (p<0.05). In pts with CR secondary to MVP, frequency of male gender (p<0.05), mean age (p0.05), functional class (p < 0.05), pulmonary artery systolic pressure (p< 0.05), frequency of acute decompensation (p< 0.05), infective endocarditis (p<0.05) and mitral valve surgery (p<0.05) were found to be lower in group with CR secondary to MVP than in pts with CR due to RMVD. In pts with MVP mean age(p<0.05), frequency of male gender (p<0.05), anterolateral (p<0.05) and postemmedial chordal length (p<0.05) were higher in pts with CR than in patients without. However in pts with rheumatic mitral regurgitation, mean age and gender were not different (p>0.05),but anterolateral (pKeywords: Chordal rupture, mitral valve prolapse, rheumatic mitral valve disease