TRANSESOPHAGEAL ECHOCARDIOGRAPHIC APPEARA NCES OF RUPTURED CHORDAE TENDINAE IN THE ELDERLY

Ruptured mitral chordae tendinae is a classical complication of myxoma tous mitral valves or Barlow's syndrome. This complication is controve rsial in non-myxomatous mitral valve. Of 91 consecutive patients with mitral valve prolapse examined over an 18 months period by transthorac ic and transesophageal echocardiography, 42 (18 women and 24 men) with an average age of 76 +/- 8 years (60-93 years) had ruptured mitral ch ordae tendinae. The thickness of the anterior mitral leaflet measured at the distal third of the valve by transesophageal echocardiography e nabled the identification of two groups of patients; group I:>3 mm (24 patients), average 4.8 +/- 0.8 mm and group II:less than or equal to 3 mm (18 patients), average 2.6 +/- 0.3 mm. The diameter of the mitral ring and left atrium, the length of the anterior mitral leaflet, the left ventricular end diastolic dimensions and fractional shortening, w ere measured by transthoracic 2D echocardiography (mitral ring) and M mode (other parameters). Ruptured chordae were detected in only 13 cas es (31%) by transthoracic echocardiography; 38% were asymptomatic and a chance finding at transesophageal echocardiography. No significant d ifference was observed between the two groups with respect to age, gen der presence of hypertension, dimensions of the cardiac chambers, frac tional shortening or localisation of the prolapse related to the ruptu red chordae. Fifty-eight per cent of patients in group I were in NYHA functional classes 3-4 as compared to 16% in group II(p<0.02). The siz e of the left atrium was significantly greater in group I,51 +/- 8 mm vs 38 +/- 7 mm (p<0.001). Two-dimensional color Doppler enabled differ entiation between moderate and significant mitral regurgitation. Signi ficant mitral regurgitation was more common in group I(p<0.02). Theref ore, ruptured chordae tendinae is common in non-myxomatous mitral valv e in the elderly, usually as an asymptomatic finding. Transesophageal echocardiography is the diagnostic method of reference. The NYHA funct ional class, left atrial and mitral ring dilatation, are associated wi th mitral regurgitation of greater severity and are more common in chr onic mitral regurgitation in myxomatous valves.