Mitral insufficiency due to ruptured chordae tendineae

The clinical features in six patients with mitral insufficiency due to chordae tendineae have been. The patients in whom the etiology was not known did not become symptomatic till they were past 40, although a murmur had been present for several years. Pulmonary edema or paroxysmal nocturnal dyspnea were the initial symptoms in a number of these patients, preceding the more usual shortness of breath with exertion. The auscultatory and phonocardiographic features are specific. On fluoroscopy readily recognizable paradoxical pulsation of the left atrium was present in some of them. At cardiac catheterization a tall left atrial “v” wave with peak pressure as high as or higher than the peak pressure in the pulmonary artery was constantly found. In a patient with mitral insufficiency where the murmur is harsh and accompanied by a thrill in the fourth intercostal space near the left sternal border and in whom an ejection type systolic murmur is heard unaccompanied by the slow rising pulse of aortic stenosis, the possibility of mitral insufficiency due to ruptured chordae tendineae should be considered