[A successful surgical replacement for mitral regurgitation after cardiac arrest due to widely ruptured chordae tendineae].

A 47-year-old woman, who has mitral regurgitation previously diagnosed in another hospital, was transferred to our intensive care unit for acute congestive heart failure. Just after admission, her respiratory state became worse and she suddenly fell into cardiac arrest. Five minutes later she recovered through cardiopulmonary resuscitation. The pulmonary artery pressure, however, which reached 85/43 mmHg with a Swan-Ganz catheter, had been exceeding systemic pressure. On echocardiography ruptured chordae tendineae of the mitral anterior leaflet was most suspected. Five days after the intensive treatment with a use of IABP, we operated upon her. On the operative findings most rough zone chordae of both leaflets including two strut chordae were ruptured with severe prolapsing. Thus we chose prosthetic valve replacement rather than mitral valve repair. We replaced the mitral valve with a Carbomedix 25 mm. Postoperatively the mean pulmonary artery pressure remained still high as 40 mmHg. With a continuous intravenous administration of prostaglandin E1, the pulmonary artery pressure became lower gradually. The patient was able to wean from respirator on the 18th postoperative day. The patient was discharged on the 49th postoperative day. The mitral valve removed at operation showed myxomatous degeneration and idiopathic ruptured chordae tendineae on the pathological examination. In summary a 47-year-old woman underwent mitral valve replacement 5 days after cardiac arrest from acute severe mitral regurgitation due to widely ruptured chordae tendineae of both leaflets. She survived the operation and got well. The mitral valve showed myxomatous degeneration on pathological examination.