Mitral regurgitation due to rupture of chordae tendineae by calcified atrial myxoma.

Abstract

DiscussionThese results show that AH 7725 when given by mouth can inhibit the immediate bronchial response to inhaled antigen in asthmatic patients. It has no bronchodilator effect (Gayrard, 1974) and its activi.ty is most likely to be explained by the inhibition of release of mediators of immediate-type allergic responses, which has already been shown in laboratory work.AH 7725 has similar inhibitory properties to those of disodium cromoglycate and also to those of its own predecessors AH 6556 and AH 7079 (Assem, 1973; Assem and McAllen, 1973 b). It is, however, exceptional in being active when given by mouth. So far as we know this is the first report on a d1rug for the prophylaxis of asthma which is active when given by mouth.Our Journal, 1974, 2, 95-96 Patienits with left atrial myxoma characteristically present with a history of progressive shortness of breath, often punctuated by syncopal attacks, and physical signs of miitral valve obstruction (Goodwin, 1963;Greenwood, 1968; Harvey, 1968). Predominant or "pure" mitral regurgitation due to left atrial myxoma has been reported but is uncommon (Cohen et al., 1963;Penny et al., 1967;Wittenstein et al., 1959). This report describes a patient with a calcified left atrial myxoma who presented with sudden severe mitral regurgitation due to ruptured chordae tendineae.Case Report A 44-year-old machinist, previously well and active, abruptly developed dyspnoea and orthopnoea during the first week of December 1972. He was admitted to his local hospital where he was found to have cardiac enlargement, pulmonary oedema, and bilateral pleural effusion. The electrocardiogram showed sinus rhythm with evidence of left atrial enlargement. A heart murmur had been heard one year earlier, but he was told "not to worry" about his heart. There was no history of rheumatic fever, chest pain, calf tendemess or swelling, or fever or chills. Digitalis (digoxin 0-25 mg/day) and a diuretic (Lasix Cardiology Section, Medical Service, Eastern Maine Medical Center, Bangor, Maine, 0441, U.S.A. JOE R. WISE, juN., M.D., Attending Physician 40 mg/day) were given but dyspnoea, orthopnoea, and fatigue persisted, atrial fibrillation developed, and he was referred for consultation.On examination he was very thin and dyspnoeic at rest. Atrial fibrillation was present, the blood pressure was 110/60 mm Hg, there were no signs of peripheral embolism, and the optic fundi were normal. The carotid pulse was small and rapid, the venous pressure was raised, and there was prominent systolic pulsation of the neck veins. The apex beat was in the mid-clavicular line and there was a prominent, diffuse systolic pulsation in the third to fifth interspaces midway between the sternum and the apex. The pulmonary valve closure sound was increased and the aortic component normal. A loud first heart sound was followed by a grade III/VI regurgitant murmur heard best at the apex. There was a prominent early third heart sound and a faint mid-diastolic apical murmur. The lungs were clear. The liver was palpable 2 cm b...

Chordal rupture. I: aetiology and natural history.

“…Chordal rupture may also be seen in association with left atrial myxoma as a result of the "wrecking ball" action of the tumour. 39 Spontaneous chordal rupture was first described in 19347 and has assumed increasing importance since then. The concept of primary spontaneous chordal rupture as distinct from ruptured chordae secondary to the causes given above was developed in 1967 by Selzer et al 20 and Auger and Wigle.40 In recent series spontaneous chordal rupture has been found to be the commonest type.244'…”

An Unusual Presentation of Cardiac Myxoma; a Case Report and Review of Literature

“…MR can be a consequence of ventricular and annular dilatation, direct leaflet damage or rarely due to rupture of Chordae Tendineae as a result of the mechanical damage of the tumor [19,23]. Since 1970, only 4 cases were reported in literature regarding left atrial myxoma presenting with preoperative severe MR as a result of chordae tendineae rupture [24][25][26][27].…”