Echocardiographic Diagnosis of Mitral Regurgitation due to Ruptured Chordae

The echocardiographic findings from six patients with ruptured chordae tendineae from the posterial mitral valve leaflet and three with ruptured chordae from the anterior leaflet are reported; in all cases the diagnosis was later proven by openheart surgery. The constellation of echocardiographic findings suggesting iruptured chordae tendineae to the posterior leaflet are: (1) The appearance of echoes within the left atrial chamber, representing prolapse of the posterior leaflet and flail chordae tendineae. This finding, although not consistently observed, is the most pathognomonic echocardiographic sign. (2) Increased amplitude of systolic excursion of the left atrial wall, in most cases associated with normal or only mildly increased left atrial diameter. (3) Recognition of thin, low-intensity (noncalcified) mitral valve leaflets. (4) The anterior leaflet may also manifest increased amplitude of motion, and may not coapt normally with the posterior leaflet in systole. (5) Increased amplitude of motion of the interventricular septum with an increased estimated stroke volume and normal-to-increased ejection fraction. The findings suggestive of ruptured chordae tendineae to the anterior leaflet are: (1) A markedly increased amplitude of motion of the anterior mitral valve leaflet is evident. This leaflet appears to approach or touch the left ventricular septum in systole and the left atrial wall in diastole. (2) All of the findings of ruptured chordae to the posterior leaflet are also seen here, except for the observation of the posterior leaflet within the left atrial chamber. This constellation of findings has not been seen in normal indiviuals, nor is it present in patients with mitral insufficiency proven to be due to other factors, such as papillary muscle dysfunction or rheumatic heart disease. Hence, this noninvasive technic enables one to diagnose accurately the presence of mitral regurgitation due to ruptured chordae tendineae.