A Case of Hypertrophic Obstructive Cardiomyopathy with Progressive Heart Failure Due to Ruptured Mitral Chordae Tendineae

Hiromi Yano Naoki Konagai Mitsunori Maeda
Masaharu Misaka Taisuke Matsumaru Tatsuhiko Kudou
Shin Ishimaru*

(Department of Cardiothoracic Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan and The Second Department of Surgery, Tokyo Medical University*, Tokyo, Japan)

A 59-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) had been treated by β-blocker for 15 years. Since June 2001 the patient has had symptoms of heart failure on sudden onset. Transesophageal echocardiography showed ruptured mitral chordae tendineae. After medical treatment to improve heart failure, open heart surgery was performed and anterior and posterior ruptured mitral chordae tendineae were recognized. Prosthetic valve replacement was performed. Histopathologic diagnosis of the chordae tendineae was myxoid degeneration. The postoperative course was excellent. Echocardiogram demonstrated that the preoperative left ventricular pressure gradient of 55mmHg reduced to 0 mmHg postoperatively, which indicated that the left ventricular outlet stenosis had disappeared. In patients with HOCM accompanied by ruptured mitral chordae tendineae, early diagnosis by transesophageal echocardiography and timely surgical treatment are essential for successful outcome. 
  Jpn. J. Cardiovasc. Surg. 31:132-135(2002)