This thickness was measured each time in the same place at the attachment of the tendinous chords (chordae tendineae
) to the papillary muscle of the left heart and the left ventricular wall.
The aortic valve, tricuspid chordae tendineae
, atrioventricular node, conduction bundle are all closely related to the PMVSD.
The mitral valve apparatus is composed of valve leaflets, mitral annulus, chordae tendineae
(CT), papillary muscles, left ventricular and atrial walls (Figure 1).
Nodular thickening of mitral valve, aortic valve, shortening of chordae tendineae
and vegetations in cardiac valves were noted in some autopsy studied.
Intraoperatively, the tumor base was located at the leading edge of the anterior leaflet of the tricuspid valve, with some involvement of the chordae tendineae
and the papillary muscles.
In the longitudinal section, some focal areas of widespread myocardiosclerosis were noted, but the integrity of papillary muscles and chordae tendineae
79 had a rupture of the tricuspid chordae tendineae
during the procedure causing severe tricuspid regurgitation, which was finally repaired through surgery.
The main drawback of standard flouroscopy is the inability to differentiate between the chordae tendineae
and papillary muscles of the heart and other soft tissue structures in the area.
A transesophageal echocardiogram more clearly pointed out the presence of systolic anterior motion (SAM) of the anterior mitral valve leaflet (Figures 1(c) and 1(d)), but there was also a thicker subvalvular structure attached to the ventricular surface of the anterior mitral leaflet which was noted as not typical of chordae tendineae
. The anterior mitral valve leaflet appeared redundant, and color Doppler demonstrated a severe, posteriorly directed mitral regurgitant jet into a moderately enlarged left atrial cavity (Figures 1(e) and 1(f)).
The anterior commissure leaflet was resected together with the vegetation and ruptured chordae tendineae
, followed by mitral valve replacement.