Severe continuous prosthetic mitral regurgitation from chordal rupture after valve-sparing replacement: a case report.
- 1Cardiovascular Ultrasound Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. [email protected].
- 2Cardiovascular Ultrasound Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Abstract
Background
After mitral valve replacement with preservation of the subvalvular apparatus, prosthetic dysfunction resulting from retained native structures is extremely rare. When it occurs, it may directly threaten the patient's life. We report an unusual case of severe regurgitation resulting from preserved chordal rupture. The key distinction of this case is the presentation of late, severe continuous prosthetic regurgitation and reversibility.Case presentation
A 54-year-old man had undergone double mechanical valve replacement for severe rheumatic mitral stenosis with mild regurgitation and concomitant aortic regurgitation three years earlier. During surgery, the posterior mitral leaflet and its entire subvalvular apparatus were preserved. Current transesophageal echocardiography revealed a mobile, cord-like structure between the lateral occluder and the prosthetic sewing ring, interfering with leaflet excursion and preventing full closure. This was accompanied by severe prosthetic mitral continuous regurgitation. Surgical findings revealed a ruptured chordae tendineae at the papillary muscle attachment, with the remnant preventing leaflet coaptation. Surgical excision of the ruptured chordal remnant successfully restored normal leaflet function, with complete resolution of the regurgitation confirmed on intraoperative transesophageal echocardiography.Conclusions
When obstruction or regurgitation develops after valve replacement with subvalvular preservation, uncommon causes-such as residual subvalvular tissue or ruptured chordal entrapment-should be considered after excluding more common etiologies. This case illustrates the critical role of transesophageal echocardiography in the diagnosis of chordal entrapment after mitral valve replacement and potentially in preventing complications. The potential benefit of preserving the subvalvular apparatus warrants thoughtful deliberation. Surgical removal of the offending tissue or valve replacement remains the definitive treatment.
Related
- Five-year outcomes of chordal replacement therapy for primary mitral regurgitation: The CHAGALL (CHordArt System Study for the Treatment of Mitral ReGurgitAtion due to Leaflet ProLapse or fLail) study.
- Skirted Prosthetic Valves Are Associated With Increased Risk of Subclinical Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: A Multicenter Study
- Clinical Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Pure Native Aortic Regurgitation: A Systematic Review and Meta-Analysis
- Coexisting Moderate-to-Severe Tricuspid Regurgitation and Renal Dysfunction Identify a High-Risk Group After Transcatheter Aortic Valve Replacement
- Outcomes of Surgical Versus Transcatheter Mitral Valve Repair or Replacement in Patients With Myocardial Infarction and Concomitant Mitral Regurgitation: A Retrospective Analysis of Real-World Data
BibTeX
@article{wang2026severe,
title = {{Severe continuous prosthetic mitral regurgitation from chordal rupture after valve-sparing replacement: a case report.}},
author = {Hongxia Wang and Yun Mou and Jiabin Yuan},
journal = {Journal of cardiothoracic surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04656-y},
url = {https://europepmc.org/article/MED/42907883},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Severe continuous prosthetic mitral regurgitation from chordal rupture after valve-sparing replacement: a case report.
AU - Hongxia Wang
AU - Yun Mou
AU - Jiabin Yuan
PY - 2026
DA - 2026/07/01
JO - Journal of cardiothoracic surgery
DO - 10.1186/s13019-026-04656-y
UR - https://europepmc.org/article/MED/42907883
AB - Background After mitral valve replacement with preservation of the subvalvular apparatus, prosthetic dysfunction resulting from retained native structures is extremely rare. When it occurs, it may directly threaten the patient's life. We report an unusual case of severe regurgitation resulting from preserved chordal rupture. The key distinction of this case is the presentation of late, severe continuous prosthetic regurgitation and reversibility.Case presentation A 54-year-old man had undergone double mechanical valve replacement for severe rheumatic mitral stenosis with mild regurgitation and concomitant aortic regurgitation three years earlier. During surgery, the posterior mitral leaflet and its entire subvalvular apparatus were preserved. Current transesophageal echocardiography revealed a mobile, cord-like structure between the lateral occluder and the prosthetic sewing ring, interfering with leaflet excursion and preventing full closure. This was accompanied by severe prosthetic mitral continuous regurgitation. Surgical findings revealed a ruptured chordae tendineae at the papillary muscle attachment, with the remnant preventing leaflet coaptation. Surgical excision of the ruptured chordal remnant successfully restored normal leaflet function, with complete resolution of the regurgitation confirmed on intraoperative transesophageal echocardiography.Conclusions When obstruction or regurgitation develops after valve replacement with subvalvular preservation, uncommon causes-such as residual subvalvular tissue or ruptured chordal entrapment-should be considered after excluding more common etiologies. This case illustrates the critical role of transesophageal echocardiography in the diagnosis of chordal entrapment after mitral valve replacement and potentially in preventing complications. The potential benefit of preserving the subvalvular apparatus warrants thoughtful deliberation. Surgical removal of the offending tissue or valve replacement remains the definitive treatment.
SN - 1749-8090
ER -