Clinical characteristics of ruptured chordae tendineae in hospitalized patients: Primary tear versus infective endocarditis

Background: Several etiologies have been associated with the rupture of chordae tendineae. The leading causes are infective endocarditis, primary rupture, and the association with various connective tissue disorders. Hypothesis: In order to define the attributes of these patients, a retrospective study was conducted that investigated the medical files of hospitalized patients in the Sheba Medical Center, Tel-Hashomer, Israel. Methods: Twenty patients (17 men, 3 women) with ruptured chordae 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 endocarditis (67.4 ± 11.3 vs. 57 ± 9.3 years, respectively, p<0.05). Results: The posterior mitral valve cusp was more commonly involved (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 endocarditis are leading etiologies of ruptured chordae tendineae in hospitalized patients. Particularly among the patients with infective endocarditis, concomitant MVP was frequently detected. It is the authors' opinion that this coexistence implies that MVP may predispose to the rupture of chordae tendineae.