Determination of Operability and Prognosis

Twenty patients with mitral insufficiency (MI) due to ruptured chordae tendineae, papillary muscle infarction, or left ventricular enlargement with no organic disease of the mitral valve have been studied during the past 3 years. Nineteen had valve re-placement, and one had plastic repair of ruptured chordae tendineae; all have been followed from 6 months to 3 years. Preoperative data were different in those who were improved by surgery (13 patients) and those who were not (seven patients). The group in which good results were obtained had a short history of heart failure, little or no evidence of left atrial (LA) enlargement in the electrocardiograms and x-rays, and striking LA v waves at catheterization. In the group demonstrating poor results, heart failure was of longer duration, gross four-chamber cardiomegaly was present, and LA v waves were only moderate. Thus, patients with nonrheumatic mitral in-sufficiency with high-pressure LA regurgitant waves and only moderate LA enlargement are likely to benefit from mitral valve surgery, even when the primary cardiovascular disease is hypertension, arteriosclerosis, or a cardiomyopathy. These patients generally have ruptured chordae tendineae. Additional Indexing Words: Hypertension Mitral valve surgery Ruptured chordae tendineae Left atrial v waves Atrial compliance RECOGNITION of severe and rapidly progressive mitral insufficiency in pa-tients with no background of rheumatic valvu-lar disease has been increasing recently. These patients give no history of acute rheumatic fever or of a long-known heart murmur and typically present with advanced congestive heart failure, a murmur suggesting mitral in