From the Research
Mitral valve repair is the preferred treatment option for mitral valve chordae tendineae dysfunction, as it preserves left ventricular function and avoids anti-coagulation therapy. Treatment options for mitral valve chordae tendineae dysfunction include both medical management and surgical interventions depending on severity. Medical therapy focuses on symptom management with diuretics, ACE inhibitors, and beta-blockers to control heart rate and reduce fluid overload. For patients with atrial fibrillation, anticoagulation with warfarin or direct oral anticoagulants is essential to prevent thromboembolic events 1.
Surgical Options
Surgical options are recommended for severe mitral regurgitation or symptomatic patients and include mitral valve repair or replacement. Repair techniques involve chordal reconstruction, transfer, or replacement with artificial chordae made of expanded polytetrafluoroethylene sutures. Minimally invasive approaches and transcatheter procedures are emerging options for high-risk patients. The choice between medical and surgical management depends on symptom severity, degree of regurgitation, left ventricular function, and patient comorbidities.
Recent Evidence
A recent study published in 2023 found that valvuloplasty at the time of septal myectomy is safe with an acceptably low rate of recurrent MR requiring prosthetic replacement in patients with hypertrophic cardiomyopathy 2. Another study published in 2024 presented an unusual case of acute severe MR due to ruptured chordae tendineae, highlighting the importance of early recognition and prompt surgical intervention 3.
Key Considerations
Early intervention before significant ventricular dysfunction develops generally leads to better outcomes, as chordae tendineae rupture or elongation disrupts normal mitral valve function, causing regurgitation that can lead to heart failure if left untreated. The most recent and highest quality study, published in 2023, supports the use of mitral valve repair as the preferred treatment option for mitral valve chordae tendineae dysfunction 2.
Management Approach
The management approach should be individualized, and a multi-disciplinary team approach should be utilized. Diagnostic and therapeutic steps should be tailored to each patient's specific needs, taking into account the underlying cause of the mitral valve chordae tendineae dysfunction and the presence of any comorbidities. Echocardiography with Doppler provides vital information related to the underlying pathology, and coronary arteriography should be performed in patients with an acute myocardial infarction to define coronary anatomy and need for revascularization 1.
Outcome Prioritization
The primary goal of treatment is to improve morbidity, mortality, and quality of life outcomes. By prioritizing mitral valve repair and early intervention, patients with mitral valve chordae tendineae dysfunction can experience improved symptoms, reduced risk of heart failure, and enhanced overall quality of life.