chordae tendineae rupture
DESCRIPTION
AM Report TJ O’Neill 3/24/10. CHORDAE TENDINeAE RUPTURE. Cardiogenic Shock w/ Preserved EF. With pulmonary edema Acute severe aortic regurgitation Acute severe mitral regurgitation Without pulmonary edema Cardiac Tamponade Acute massive PE Acute RV infarction. Chordae Rupture. - PowerPoint PPT PresentationTRANSCRIPT
AM ReportTJ O’Neill 3/24/10
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
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
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
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
Chordal RuptureDiagnosis
Flail mitral leaflet
Chordal RuptureDiagnosis
Because regurgitant jet is asymmetric, pulmonary edema can occur unilaterally
NEJM 361:e6. July 30th 2009, 5.
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
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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