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. 1967 Jun 10;96(23):1493–1503.

Sudden, Severe Mitral Insufficiency

Pierre Auger, E Douglas Wigle
PMCID: PMC1923022  PMID: 4226018

Abstract

Five male patients with sudden, severe mitral insufficiency due solely to ruptured chordae tendineae or papillary muscle had an abrupt onset of symptoms of left and right heart failure and the sudden appearance of a harsh, widely propagated apical pansystolic murmur. None had a history of rheumatic fever. All were in sinus rhythm and had but mild left atrial and ventricular enlargement. Giant left atrial “v” waves were characteristic and exceeded pulmonary artery pressure in two instances.

In contrast, when ruptured chordae tendineae were superimposed on chronic rheumatic mitral insufficiency, females predominated and there was a long history of disability. Atrial fibrillation, less elevation of left atrial pressure, and marked left atrial and ventricular enlargement were characteristic. These latter patients closely resembled patients with chronic rheumatic mitral insufficiency alone.

It is concluded that the syndrome of sudden, severe mitral insufficiency develops if ruptured chordae tendineae occur on a previously normal or insignificantly diseased mitral valve. If ruptured chordae tendineae are superimposed on chronic rheumatic mitral insufficiency, the syndrome resembles that seen in the latter alone.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASKEY J. M. Spontaneous rupture of a papillary muscle of the heart; review with 8 additional cases. Am J Med. 1950 Oct;9(4):528–540. doi: 10.1016/0002-9343(50)90204-x. [DOI] [PubMed] [Google Scholar]
  2. Austen W. G., Sanders C. A., Averill J. H., Friedlich A. L. Ruptured papillary muscle. Report of a case with successful mitral valve replacement. Circulation. 1965 Oct;32(4):597–601. doi: 10.1161/01.cir.32.4.597. [DOI] [PubMed] [Google Scholar]
  3. BARRATT-BOYES B. G. SURGICAL CORRECTION OF MITRAL INCOMPETENCE RESULTING FROM BACTERIAL ENDOCARDITIS. Br Heart J. 1963 Jul;25:415–420. doi: 10.1136/hrt.25.4.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. BERMAN R. Ruptured mitral chordae tendineae in subacute bacterial endocarditis. J Lancet. 1962 Feb;82:48–50. [PubMed] [Google Scholar]
  5. BJORK V. O., MALMSTROM G., UGGLA L. G. Left auricular pressure measurements in man. Ann Surg. 1953 Nov;138(5):718–725. doi: 10.1097/00000658-195311000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. BRAUNWALD E., AWE W. C. The syndrome of severe mitral regurgitation with normal left atrial pressure. Circulation. 1963 Jan;27:29–35. doi: 10.1161/01.cir.27.1.29. [DOI] [PubMed] [Google Scholar]
  7. BRENEMAN G. M., DRAKE E. H. Ruptured papillary muscle following myocardial infarction with long survival. Report of two cases. Circulation. 1962 May;25:862–868. doi: 10.1161/01.cir.25.5.862. [DOI] [PubMed] [Google Scholar]
  8. BURCHELL H. B., EDWARDS J. E., HEPPER N. G. Cardiac clinics. CXLVI. Mitral insufficiency in healed, unrecognized bacterial endocarditis. Proc Staff Meet Mayo Clin. 1956 Dec 12;31(25):659–664. [PubMed] [Google Scholar]
  9. CEDERQVIST L., SOEDERSTROEM J. PAPILLARY MUSCLE RUPTURE IN MYOCARDIAL INFARCTION. A STUDY BASED UPON AN AUTOPSY MATERIAL. Acta Med Scand. 1964 Sep;176:287–292. [PubMed] [Google Scholar]
  10. DAVILA J. C., KYLE R. H., GLOVER R. P. Mitral regurgitation due to ruptured chordae tendineae correction by mitral pursestring. Am Heart J. 1957 Dec;54(6):940–946. doi: 10.1016/0002-8703(57)90199-0. [DOI] [PubMed] [Google Scholar]
  11. DODGE H. T., HAY R. E., SANDLER H. Pressure-volume of the diastolic left ventricle of man with heart disease. Am Heart J. 1962 Oct;64:503–511. doi: 10.1016/0002-8703(62)90036-4. [DOI] [PubMed] [Google Scholar]
  12. GORELICK M. M., LENKEI S. C., HEIMBECKER R. O., GUNTON R. W. Estimation of mitral regurgitation by injection of dye into the left ventricle with simultaneous left atrial sampling. A clinical study of sixty confirmed cases. Am J Cardiol. 1962 Jul;10:62–69. doi: 10.1016/0002-9149(62)90268-0. [DOI] [PubMed] [Google Scholar]
  13. HANSEN J. Spontaneous rupture of a papillary muscle of the heart. Report of three cases. Acta Med Scand. 1962 Nov;172:531–534. doi: 10.1111/j.0954-6820.1962.tb07188.x. [DOI] [PubMed] [Google Scholar]
  14. HOLLOWAY D. H., Jr, WHALEN R. E., MCINTOSH H. D. SYSTOLIC MURMUR DEVELOPING AFTER MYOCARDIAL ISCHEMIA OR INFARCTION: DIFFERENTIAL DIAGNOSIS. JAMA. 1965 Mar 15;191:888–892. doi: 10.1001/jama.1965.03080110012002. [DOI] [PubMed] [Google Scholar]
  15. HOPE R. B., ASKEY J. M. Necrosis of a cardiac papillary muscle following infarction with incomplete rupture. Am Heart J. 1952 Aug;44(2):306–310. doi: 10.1016/0002-8703(52)90156-7. [DOI] [PubMed] [Google Scholar]
  16. Horlick L., Merriman J. E., Robinson L. N. A case of mitral insufficiency following myocardial infarction with rupture of a papillary muscle: improvement following reattachment of the papillary muscle and plication of the mitral valve. Can Med Assoc J. 1966 Jan 22;94(4):192–195. [PMC free article] [PubMed] [Google Scholar]
  17. JANUARY L. E., FISHER J. M., EHRENHAFT J. L. Mitral insufficiency resulting from rupture of normal chorade tendineae. Report of a surgically corrected case. Circulation. 1962 Dec;26:1329–1333. doi: 10.1161/01.cir.26.6.1329. [DOI] [PubMed] [Google Scholar]
  18. KAY J. H., EGERTON W. S. The repair of mitral insufficiency associated with ruptured chordae tendineae. Ann Surg. 1963 Mar;157:351–360. doi: 10.1097/00000658-196303000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. LEVINSON D. C., WILBURNE M., MEEHAN J. P., Jr, SHUBIN H. Evidence for retrograde transpulmonary propagation of the V (or regurgitant) wave in mitral insufficiency. Am J Cardiol. 1958 Aug;2(2):159–169. doi: 10.1016/0002-9149(58)90226-1. [DOI] [PubMed] [Google Scholar]
  20. MARSHALL H. W., WOODWARD E., Jr, WOOD E. H. Hemodynamic methods for differentiation of mitral stenosis and regurgitation. Am J Cardiol. 1958 Jul;2(1):24–60. doi: 10.1016/0002-9149(58)90245-5. [DOI] [PubMed] [Google Scholar]
  21. MAURICE P., SCEBAT L., RENAIS J., LENEGRE J. ETUDE ANATOMIQUE DE 291 CAS D'INSUFFISANCE MITRALE. Acta Cardiol. 1964;19:499–517. [PubMed] [Google Scholar]
  22. MORRIS J. D., PENNER D. A., BRANDT R. L. SURGICAL CORRECTION OF RUPTURED CHORDAE TENDINEAE. J Thorac Cardiovasc Surg. 1964 Nov;48:772–780. [PubMed] [Google Scholar]
  23. NIXON P. G. The third heart sound in mitral regurgitation. Br Heart J. 1961 Nov;23:677–689. doi: 10.1136/hrt.23.6.677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. NIXON P. G., WOOLER G. H., RADIGAN L. R. The opening snap in mitral incompetence. Br Heart J. 1960 Jun;22:395–402. doi: 10.1136/hrt.22.3.395. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. PECKHAM G. B., CHRYSOHOU A., ALDRIDGE H. E., WIGLE E. D. COMBINED PERCUTANEOUS RETROGRADE AORTIC AND TRANSSEPTAL LEFT HEART CATHETERIZATION. Br Heart J. 1964 Jul;26:460–468. doi: 10.1136/hrt.26.4.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. PERRIN A., FROMENT R., PASQUIER J. [Mitral insufficiency caused by luxation of the small valve and rupture of the cords. (Apropos of 5 anatomo-clinical observations simulating aortic stenosis]. Arch Mal Coeur Vaiss. 1961 Jan;54:82–94. [PubMed] [Google Scholar]
  27. RADNER S. Left atrial pressure curve: significance of annular ascent wing. Acta Med Scand. 1957 Nov 29;159(3):219–223. doi: 10.1111/j.0954-6820.1957.tb00128.x. [DOI] [PubMed] [Google Scholar]
  28. Roberts W. C., Braunwald E., Morrow A. G. Acute severe mitral regurgitation secondary to ruptured chordae tendineae: clinical, hemodynamic, and pathologic considerations. Circulation. 1966 Jan;33(1):58–70. doi: 10.1161/01.cir.33.1.58. [DOI] [PubMed] [Google Scholar]
  29. SANDERS R. J., NEUBUERGER K. T., RAVIN A. Rupture of papillary muscles: occurrence of rupture of the posterior muscle in posterior myocardial infarction. Dis Chest. 1957 Mar;31(3):316–323. doi: 10.1378/chest.31.3.316. [DOI] [PubMed] [Google Scholar]
  30. SELDINGER S. I. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta radiol. 1953 May;39(5):368–376. doi: 10.3109/00016925309136722. [DOI] [PubMed] [Google Scholar]
  31. SHAPIRO H. A., WEISS D. R. Mitral insufficiency due to ruptured chordae tendineae simulating aortic stenosis. N Engl J Med. 1959 Aug 6;261(6):272–276. doi: 10.1056/NEJM195908062610604. [DOI] [PubMed] [Google Scholar]
  32. SOULIE P., ACAR J., BERNADOU A., CARAMANIAN M. LES RUPTURES DE CORDAGES DE L'APPAREIL MITRAL. LEUR 'ETIOLOGIE. APROPOS DE 27 CAS. Arch Mal Coeur Vaiss. 1965 Apr;58:457–475. [PubMed] [Google Scholar]
  33. Soulié P., Degeorges M., Acar J., Delzant J. F. Indications et résultats de la chirurgie de l'insuffisance mitrale. A propos de 33 observations. Mal Cardiovasc. 1965;6(4):579–605. [PubMed] [Google Scholar]
  34. WOLNISTY C., FRIEDMAN S. L. MITRAL INSUFFICIENCY SECONDARY TO RUPTURED CHORDAE TENDINEAE. REPORT OF A SURGICALLY CORRECTED CASE. JAMA. 1964 May 18;188:687–689. doi: 10.1001/jama.1964.03060330067022. [DOI] [PubMed] [Google Scholar]
  35. Wigle E. D., Labrosse C. J. Sudden, severe aortic insufficiency. Circulation. 1965 Nov;32(5):708–720. doi: 10.1161/01.cir.32.5.708. [DOI] [PubMed] [Google Scholar]

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