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You are here: Contents > 2018-19 > Volume 27 Number 5 (2018-19) > MITRAL VALVE DISEASE > Isolated Chordal Shortening: A Novel Mechanism of Functional Mitral Regurgitation

Isolated Chordal Shortening: A Novel Mechanism of Functional Mitral Regurgitation

Roland Hetzer, Mariano Javier, Eva Maria Delmo Walter

1Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
2Electronic correspondence: danspevack@gmail.com

Background and aim of the study: Mitral regurgitation (MR) that occurs in the absence of primary leaflet disease is known as functional MR. The condition generally results from left ventricular (LV) enlargement, altered geometry of the papillary muscles, and or dilatation of the mitral valve annulus. At the authors’ institution, a group of patients was noted with surgical MR in the absence of these features. Details are presented of a cohort of patients with MR secondary to isolated chordal shortening.

Methods: The authors’ hospital system database was searched for all subjects who underwent mitral valve surgery for regurgitation between 2006 and 2012 (n = 658). The study population incorporated subjects found to have normal mitral leaflet appearance, normal left ventricular size and function with a normal mitral annular dimension by echocardiography. Valve morphology and appearance were confirmed by inspection during surgery and by pathological examination when available. Mitral valve tethering parameters were compared to sample subjects with normal valves, and to sample subjects with severe ischemic functional MR. Both control groups were matched to the study cohort by age, gender, and body surface area.

 

 

Results: Ten subjects were identified who met the inclusion criteria. None had any history of rheumatic fever, endocarditis, or other systemic inflammatory conditions. On surgical inspection, chordal shortening or restriction was reported in six subjects, and chordal thickening or fibrosis was noted in two. For the six patients who underwent valve replacement the excised portions of the leaflets demonstrated generally normal gross appearance. Compared to normal controls, the study group had shorter chordae, increased mitral tenting heights, and smaller mitral annular diameters. Compared to the control group with severe ischemic MR, the study group had shorter chordae, smaller leaflet tenting heights, smaller tenting areas, and smaller mitral annular diameters.

Conclusion: A series is reported of 10 subjects who underwent mitral valve surgery for severe regurgitation attributable to pathologically short chordae. To the authors’ knowledge this is the first description of this mechanism of disease. Further studies are required to define the underlying factors which cause isolated mitral chordal disease.

The Journal of Heart Valve Disease 2018-19;27:293-299

Isolated Chordal Shortening: A Novel Mechanism of Functional Mitral Regurgitation

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