[Echocardiographic recognition of ruptured chordae tendineae: patho-anatomical evaluation of the diagnostic criteria].

Various pathological changes of the mitral valve (MV) apparatus have been reported to be associated with ruptured chordae tendineae (RCT). We studied the clinical importance of echocardiographic examination to detect the etiology of RCT in 15 cases with patho-anatomical findings obtained. The commonly observed echocardiographic abnormalities were diastolic MV flutter (80%), systolic MV vibration (73%), flicky (or exaggerated) MV motion (73%), MV prolapse (47%), and abnormal systolic echoes in the left atrium (53%). Diastolic flicky motion of the MV was observed exclusively in the patients of bacterial endocarditis accompanied with MV vegetations. The main ruptured chordae of the MV were recognized as floating chordal echoes. MV prolapse was associated with myxomatous changes of the valve or multiple echoes chordae tendineae. These results show that M-mode and two-dimensional echocardiography may be predictive to evaluate the etiology of RCT.