Mitral regurgitation with rupture of normal chordae tendineae.

Surgery for mitral incompetence still presents a challenge despite the great advance made by the introduction of prosthetic valves. In view of the high incidence of late complications of prostheses (Du Plessis et al., 1965), we believe that, whenever possible, the natural valve should be preserved. Unfortunately this can be done only in cases of pure or dominant stenosis and in those ofmitral regurgitation due to a localized defect or a grossly dilated annulus. Partial retention of the valve is seldom practicable because of the lack of suitable materials for leaflet substitution and the uncertainty of com- petency after a long intricate operation. We have, however, been able to retain the valves of six patients with severe mitral regurgitation resulting from ruptured chordm tendinee. This paper describes the anatomical features and surgical management of these cases and discusses the probable mechanism of the chordal disruption.