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severe mitral insufficiency caused by mitral valve prolapse

added by Emmel

severe mitral insufficiency caused by mitral valve prolapse
Posted By: Emmel (2313 days ago)

Hello friends!!

Thank you so much for comments.
are right! That case is very strange. The symptoms of clinical
afflictions were about 6-8 weeks and they were only subjektive minor
complaints (minor dyspnoea on exertion at first). The patient was
admitted to our ER with severe dyspnoea of the last 3-4 days. Besides
the patient is very indolent!!
The left atrium is very dilated so
I´m under the impression that there is no acute rupture of chordae
tendinea with following acute mitral valve insufficiency. We couldn´t
found another reason for that rupture. No elevated inflammation
marker, no signs for autoimmune disturbance, no sign´s for
Very good eyeballing, Pablo: you are right: the
LV-function is impaired. and the RV-diameter is very extented wit
severe increase of pulmonary pressure (PAPsystol 110 mmHg + ZVD!!!)
(Unfortunately I couldn´t convert that pictures of PAP to a clip..
We admitted that patient to the cardiac surgery for
mitral valve rekonstruction.

Posted By: drdavemd (2314 days ago)

That is really strange, chordae rupture without any other systemic
illnesses? Especially odd that he is so young. How long were his
symptoms before he presented?

Posted By: ohtusabes (2314 days ago)

Hello Jörg. Very interesting case!!!

Some questions?/>How is left atrial area?
Is LV diameter normal? RV

In eyeballing it seems LV is not
hyperdinamyc...acute severe mitral regurgitation reduces LV afterload
a lot...so LV contractility must be really hyperdinamyc (EF more than
70 %)...and this is not the case...so...I asume LV function previously
is not good...

One posibility is a myxomatous valve and
this predisposes to rupture of chordae tendinosa?

Best />Pablo

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Added: 17-04-2012
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about 50 y old man with distinct dyspnoea in context of lung oedema. In TTE and TEE we found a severe mitral valve insufficiency with regurgitation in pulmonary veins caused by mitral valve prolapse in context of rupture of chorda tendinea. The reason of the ruptur of chorda tendinea is not clear: no myocardial ischemia (no elevated troponin, no coronary occlusion in cardiac catheter) and no sign of endocarditis (no elevated values of inflammation). Some idea? After recompensation the patient was admitted to cardiac surgery for mitral valve reconstruction.

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