Ruptured mitral chordae tendineae may be a frequent and insignificant complication in the mitral valve prolapse syndrome

In this study, we performed 512 echocardiographic studies on 264 consecutive, unselected patients with the idiopathic mitral valve prolapse syndrome. Twenty-eight patients (10.6%) had evidence of ruptured chordae tendineae of the mitral valve on M-mode examination and in 24 the diagnosis was confirmed by two-dimensional echocardiography. Mild to severe mitral insufficiency was proven in all of them by left ventriculography during cardiac catheterization. Eight patients underwent surgery to relieve symptomatic severe mitral regurgitation. At operation all had myxomatous degeneration of the mitral valve, two patients were found to have rupture of anterior mitral chordae, and six had rupture of posterior mitral chordae. Twenty (71%) patients with chordal rupture had either mild symptoms or were completely asymptomatic. It is concluded that chordal rupture in patients with the mitral valve prolapse syndrome may be present in asymptomatic patients and go undetected clinically in a substantial number of patients unless a high index of suspicion is maintained. Serial M-mode and two-dimensional echocardiographic studies are of importance in identifying the progression of prolapse findings and may reveal the natural history of this pathologic condition in asymptomatic patients.