CASE REPORT

REPAIR OF IDIOPATHIC RUPTURE OF MITRAL CHORDAE TENDINEA BY TRIANGULAR RESECTION AND ANNULOPLASTY

Turkan Tansel; Murat Ugurlucan*; Eylul Kafal¦, Dr. Omer Ali Say¦n;
Murat Basaran; Enver Day¦oglu; Dr. Ertan Onursal
Istanbul University Istanbul Medical Faculty,
Department of Cardiovascular Surgery, Istanbul, Turkey

 

Abstract
 

Major causes of rupture of chordae tendinea are myocardial infarction, trauma, hypertension, myxomatous degeneration, endocarditis and rheumatic heart disease. We describe an idiopathic rupture of the chordae tendinea of the posterior mitral leaflet in a 67 years old patient who had no evidence of coronary artery disease, rheumatic disease or other etiologies. The defect was repaired with triangular resection and annuloplasty. He had an uneventful postoperative course for 5 months.
Heart Views. 2005;6(3):115-117 © 2005 Gulf Heart Association.
Key Words: Idiopathic          Ruptured Chordae Tendinea      Triangular Resection  
                       Annuloplasty.
 

The relative efficacy of pravastatin 40 mg and atorvastatin 80 mg daily to reduce LDL-C and CRP among 3,745 acute coronary syndrome patients was analyzed. A total of 1,018 participants (27.1%) achieved the dual goals of LDL-C <70 mg/dl and CRP <2 mg/l. After adjustment for age, gender, smoking, diabetes, hypertension, obesity, and HDL-C, these individuals had a 28% lower risk of recurrent myocardial infarction or vascular death (relative risk = 0.72; 95% confidence interval 0.52 to 0.99). Of those who achieved dual goals, 80.6% received atorvastatin 80 mg, while 19.4% received pravastatin 40 mg (p < 0.001). Only 11% allocated pravastatin and 44% allocated atorvastatin achieved the goals of LDL-C <70 mg/dl and CRP <2 mg/l, and only 5.8% allocated pravastatin 40 mg and 26.1% allocated atorvastatin 80 mg reached the even lower goals of LDL-C <70 mg/dl and CRP <1 mg/l. The correlation coefficient for CRP measured at 30 days and at end of study was 0.61 (p < 0.001), a value almost identical to that for LDL-C over the same follow-up period (r = 0.62, p < 0.001).

While atorvastatin 80 mg was superior to pravastatin 40 mg in terms of achieving the dual goals of aggressive LDL-C and CRP reduction, neither agent brought the majority of patients below thresholds needed to maximize patient benefit.

J Am Coll Cardiol. 2005; 45: 1644-1648