Acute congestive heart failure due to ruptured mitral chordae tendineae in late pregnancy

• Published in: The journal of obstetrics and gynaecology research Vol. 39; no. 3; pp. 724 - 726
• Main Authors: Ohishi, Sugiko, Nitta, Hayase, Chinen, Yukiko, Kinjo, Tadatsugu, Masamoto, Hitoshi, Sakumoto, Kaoru, Maeda, Tatsuya, Kuniyoshi, Yukio, Aoki, Yoichi
• Format: Journal Article
• Language: English
• Published: Australia Wiley Subscription Services, Inc 01-03-2013
• Subjects: acute heart failure; Adult; Anesthesia; Apgar score; Cesarean Section; Chordae Tendineae; Congestive heart failure; Diagnosis; Dyspnea; Echocardiography; Emergency Medical Services; Endocarditis; Female; Fetuses; Gestation; Heart failure; Heart Failure - etiology; Heart Failure - surgery; Heart surgery; Humans; Intensive care; late pregnancy; mitral chordae tendineae; Mitral valve; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - surgery; Postpartum; Pregnancy; Pregnancy Complications, Cardiovascular - etiology; Pregnancy Complications, Cardiovascular - surgery; Regurgitation; Respiration; Rupture, Spontaneous
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/j.1447-0756.2012.02014.x

A 31‐year‐old woman complained of dyspnea and orthopnea at 38 weeks of gestation. A grade 3/6 pansystolic murmur was heard, and echocardiography revealed severe mitral regurgitation with a hyperechoic obstacle on the posterior mitral valve leaflet, consistent with a diagnosis of acute heart failure due to a ruptured chordae tendineae or an infectious endocarditis. An emergency cesarean section was performed under general anesthesia. A male infant was born weighing 2928 g with Apgar scores of 7 and 8 at 1 and 5 min, respectively. The patient was managed in the intensive care unit and underwent open‐heart surgery for mitral valve repair on postpartum day 3. The two chordal tendineae appeared torn and frail, and a mitral annuloplasty was performed. No finding of infectious endocarditis was observed. Because it is a dramatic and life‐threatening clinical situation, proper diagnosis and treatment in the intensive care unit assure a good outcome for both mother and fetus.