Emergency Double Valve Replacement for Acute Mitral Regurgitation due to Ruptured Chordae Tendineae Associated with Congenital Bicuspid Aortic Valve Insufficiency

(Department of Cardiac Surgery, Jikei University Kashiwa Hospital, Chiba, Japan, Department of Cardiac Surgery, Jikei University School of Medicine*, Tokyo, Japan and Department of Cardiovascular Surgery, Saitama Cardiovascular and Respiratory Center**, Saitama, Japan)

Motohiro Oshiumi Kiyozou Morita* Kazuhiro Hashimoto**
Asatoshi Mizuno Hiromitsu Takakura** Hirokuni Naganuma
We present a rare case of mitral valve prolapse associated with congenital bicuspid aortic valve, followed by abrupt left chordae tendineae rupture resulting in severe left heart failure and cardiac arrested. The patient, a 43-year-old man who had been admitted because of sudden orthopnea suffered cardiac arrest on arrival in the emergency unit. After successful cardiopulmonary resuscitation, emergency double-valve replacement (SJM25mm for the aortic valve and Carbomedics 31mm for the mitral valve) was performed; his postoperative course was uneventful. Concerning the pathogenesis of the acute rupture of the chordae tendineae in this patient with no evidence of infective endocarditis, it was likely that chronic and progressive left ventricular volume overload due to aortic regurgitation caused by congenital bicuspid aortic valve was the causative factor of abrupt rupture of the chordae tendineae during the course of mild mitral valve prolapse.
@Jpn. J. Cardiovasc. Surg. 31: 425-427 (2002)