CLINICAL CHARACTERISTICS OF RUPTURED CHORDAE TENDINEAE IN HOSPITALIZED-PATIENTS - PRIMARY TEAR VERSUS INFECTIVE ENDOCARDITIS

Background: Several etiologies have been associated with the rupture o f chordae tendineae. The leading causes are infective endocarditis, pr imary rupture, and the association with various connective tissue diso rders. Hypothesis: In order to define the attributes of these patients , a retrospective study was conducted that investigated the medical fi les of hospitalized patients in the Sheba Medical Center, Tel-Hashomer , Israel. Methods: Twenty patients (17 men, 3 women) with ruptured cho rdae were detected. Primary rupture of the chordae tendineae had been diagnosed in 11 patients, while infectious endocarditis was the cause for the tear of the chordae tendineae in 9 patients. The patients who had primary rupture of the chordae were older than the patients with e ndocarditis (67.4 +/- 11.3 vs. 57 +/- 9.3 years, respectively, p < 0.0 5). Results: The posterior mitral valve cusp was more commonly involve d (15 patients). Six of the patients with posterior mitral valve cusp involvement manifested atrial fibrillation. Mitral valve prolapse (MVP ) was detected among seven patients, six of whom belonged to the group with infective endocarditis. Conclusion. Primary tear and infective e ndocarditis are leading etiologies of ruptured chordae tendineae in ho spitalized patients. particularly among the patients with infective en docarditis, concomitant MVP was frequently detected. It is the authors ' opinion that this coexistence implies that MVP may predispose to the rupture of chordae tendineae.