“Woodpecker” in the heart: unusual case of spontaneous chordae rupture of the mitral valve

Excerpt

A 86-year-old woman with a history of hypertension, hypercholesterolemia and diabetes presented to the outpatient clinic with 10 days of worsening dyspnea. Cardiac auscultation revealed a loud S2 and a high-pitched holosystolic murmur at the apex. End-inspiratory crackles suggested pulmonary congestion. Echocardiography revealed a normal-sized left ventricle and enlargement of the left atrium. Left ventricular ejection fraction was well preserved and ruptured chordae tendineae with an enlarged fragmented end with calcification adjacent to the tip could be demonstrated. The 2-D image of the calcified structure at the end of the ruptured chordae was mimicking a “woodpecker” moving towards the septum with each opening of the mitral valve (Panel A, B, C; Movie). Color Doppler imaging revealed an excentric mitral regurgitatant jet directed posterolaterally with proximal flow convergence indicating severe mitral regurgitation (Panel D, E, F). Pulmonary congestion resolved with symptomatic medical treatment. The patient refused mitral valve surgery and remained stable during 6 months follow-up. …