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Rupture of posterior chordae following percutaneous mitral balloon valvuloplasty for rheumatic mitral stenosis

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©Telif Hakk› 2013 AVES Yay›nc›l›k Ltd. Şti. - Makale metnine www.anakarder.com web sayfas›ndan ulaş›labilir.

©Copyright 2013 by AVES Yay›nc›l›k Ltd. - Available online at www.anakarder.com doi:10.5152/akd.2013.4853

Rupture of posterior chordae

following percutaneous mitral balloon

valvuloplasty for rheumatic mitral

stenosis

Romatizmal mitral darlığı için yapılan perkütan

mitral balon valvüloplasti sonrası posteriyor korda

rüptürü

A 31-year-old female was referred to our echo-lab due to progressive dyspnea on exertion. In her history, she underwent percutaneous mitral balloon valvuloplasty (PMBV) due to rheumatic mitral stenosis two months ago. Transthoracic echocardiography with color Doppler revealed anterior eccentric mitral regurgitation jet (Fig. 1, Video 1. See

corresponding video/movie images at www.anakarder.com). To clarify mechanism of regurgitation, we performed transesophageal echocardiography (TEE). Two-dimensional TEE demonstrated rupture of chordae on the posterior mitral leaflet (Fig. 2, Video 2. See corresponding video/movie images at www.anakarder.com). Three-dimensional TEE confirmed rupture of chordae at P2 scallop of posterior mitral leaflet (Fig. 3, Video 3. See corresponding video/movie images at www. anakarder.com). She was referred to surgery for mitral valve replacement.

Mitral regurgitation is relatively common after balloon dilatation, but is mostly mild and caused by excessive commissural tearing or slight prolapse of the anterior leaflet. In this report, we describe mitral regurgitation secondary to rupture of posterior chordae following PMBV, rupture of chordae is rare complication of PMBV especially on the posterior mitral leaflet.

Cüneyt Toprak, Gökhan Kahveci, Mehmet Mustafa Tabakçı Clinic of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul-Turkey

Video 1. With three-dimensional en face view from the left atrial aspect, rupture of chordae (arrow) on the posterior mitral leaflet was identified at the middle segment (P2 scallop)

Ao - aorta, LAA - left atrial appendage

Video 2. Two-dimensional transthoracic color Doppler echocar-diography apical four chamber movie showing anterior eccentric mitral regurgitation

Video 3. Three -dimensional transesophageal echocardiography movie, en face view from the left atrial aspect showing rupture of chordae on the middle segment (P2 scallop) of posterior mitral leaflet

Address for Correspondence/Yaz›şma Adresi: Dr. Cüneyt Toprak, Merdivenköy Mah. Merdivenköy Yolu Cad. No: 25/13

34732 Kadıköy, İstanbul-Türkiye Phone: +90 506 297 86 56 E-mail: cuneytoprak@hotmail.com

Available Online Date/Çevrimiçi Yayın Tarihi: 25.11.2013

©Telif Hakk› 2013 AVES Yay›nc›l›k Ltd. Şti. - Makale metnine www.anakarder.com web sayfas›ndan ulaş›labilir.

©Copyright 2013 by AVES Yay›nc›l›k Ltd. - Available online at www.anakarder.com doi:10.5152/akd.2013.4986

Figure 1. Two-dimensional transthoracic color Doppler echocardiography, apical four chamber view illustrating anterior eccentric mitral regurgitation jet (arrows)

Figure 3. With three-dimensional en face view from the left atrial aspect, rupture of chordae (arrow) on the posterior mitral leaflet was identified at the middle segment (P2 scallop)

Ao - aorta, LAA - left atrial appendage

Figure 2. Two-dimensional transesophageal echocardiography, midesophageal four chamber view illustrating rupture of chordae (arrow) at the middle segment (P2 scallop) of posterior mitral leaflet

LA - left atrium, LV - left ventricle

E-sayfa Özgün Görüntüler E-page Original Images Anadolu Kardiyol Derg

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