Exercise induced chordae tendinae rupture

Abstract

Introduction. Mitral valve prolapse (MVP) is the most common cardiac valve anomaly with a prevalence of 2-3% worldwide and the main cause of mitral valve (MV) surgery in the case of isolated mitral regurgitation (MR). MVP and myxomatous valve degeneration are the main causes of chordae tendinae rupture (CTR). Case description. A 68-year-old patient was physically active and asymptomatic, often engaging in running competitions, until he came to the hospital referring progressing dyspnea and chest pain. These symptoms developed one week ago when the patient lifted heavy suitcases. A physical examination showed systolic moderate murmur localized in the area of the left sternal border, aortic zone and the apex, a slight edema in the legs, other findings were normal. The laboratory tests revealed elevated NT-proBNP (341 pmol/l) and normal troponine I. The echocardiography detected dilatation of left ventricle, ejection fraction 50%, posterior leaflet of MV prolapsing into left atrium, severe MV insufficiency, moderate tricuspid valve insufficiency and significant bilateral atrial dilatation. The transesophageal echocardiography (TEE) specified myxoid changes in MV. Mitral valvoplasty was performed – thickened myxoid MV leaflets without chordae were detected. After the valvoplasty, TEE showed significant decretion in the diameter of mitral ring, MV function was normal, tricuspid valve insufficiency decreased to trivial. 8 days after the surgery, an echocardiography showed mild left ventricular dilatation and eccentric hypertrophy, severe MR decreased to only trivial regurgitation. Conclusions and summary. This case shows that even an asymptomatic MVP can have severe outcomes, which leads to a discussion about the kind of physical exercise recommended for patients with this diagnosis and whether the current guidelines stay relevant.