The molecular pathophysiology of vascular anomalies: Genomic research

Vascular anomalies are congenital localized abnormalities that result from improper development and maintenance of the vasculature. The lesions of vascular anomalies vary in location, type, and clinical severity of the phenotype, and the current treatment options are often unsatisfactory. Most vascular anomalies are sporadic, but patterns of inheritance have been noted in some cases, making genetic analysis relevant. Developments in the field of genomics, including next-generation sequencing, have provided novel insights into the genetic and molecular pathophysiological mechanisms underlying vascular anomalies. These insights may pave the way for new approaches to molecular diagnosis and potential disease-specific therapies. This article provides an introduction to genetic testing for vascular anomalies and presents a brief summary of the etiology and genetics of vascular anomalies.

Correction of microtia with constriction features using a superficial temporal fascial flap combined with a rib cartilage graft

Background@#Microtia with constricted features is characterized by a short helical length of variable severity, upper antihelical or scaphal deficiency, and a downfolded upper ear. No consensus has been reached regarding the most appropriate surgical method for this condition. In this study, we aimed to introduce a simple and safe surgical method for the correction or reconstruction of upper helix ear deformities. @*Methods@#Between February 2011 and June 2014, eight patients with microtia with constricted upper helix ear deformity underwent reconstruction of the ear deformity. The upper ear helical framework was constructed by carving and curving the eighth rib cartilage harvested from the ipsilateral chest wall, covering this cartilage with a superficial temporal fascial flap, and adjusting the skin graft to align with the ear contour. To evaluate their satisfaction, patients were asked to complete a questionnaire regarding ear shape, symmetry, position, color, and overall outcome scored on a 5-point scale at 12 months postoperatively. @*Results@#None of the patients experienced severe complications in the reconstructed ear. The preoperative and postoperative vertical ear length ratios were 0.88 and 1.02, respectively. And the mean patient satisfaction scores for shape, symmetry, position, color, and overall outcome were 4.2, 4.5, 4.7, 4.4, and 4.6 out of 5 points, respectively. All patients expressed a high level of satisfaction at 12 months postoperatively. @*Conclusions@#Our technique provides a good alternative method for the reconstruction of moderate constricted upper helix ear deformities in patients who meet the surgical indications with satisfactory outcomes and few complications.

Use of Abnobaviscum to treat refractory seroma after breast reconstruction with a latissimus dorsi flap: A case report

In recent years, there has been a notable increase in the rate of refractory donor site seroma, defined as seroma that persists for at least 3 months postoperatively, as the number of breast reconstructions using a latissimus dorsi (LD) musculocutaneous flap has increased. Various factors have been proposed to be related, including smoking, obesity, flap mass, and body weight, and several studies have been conducted to explore treatment methods. Typically, surgical treatment, such as capsulectomy, has been considered for refractory seroma, but in this case report, we describe positive outcomes achieved by using Abnobaviscum to treat three female patients who developed a donor site seroma at least 3 months after breast reconstruction using an LD flap.

Feasibility of Transradial Coronary Angiography Using a Single Judkins Left Catheter

BACKGROUND AND OBJECTIVES: Transradial coronary angiography and intervention are getting more popularity throughout the world because of lower incidence of puncture site complications and the patients have displayed early ambulation. However, radial arterial spasms and possible endothelial injury due to the small size of radial artery are troublesome. To overcome this problem, we investigated the usefulness of performing transradial coronary angiography using a single Judkins left catheter (JL). SUBJECTS AND METHODS: A total of 268 patients who underwent right transradial coronary angiography from June 2003 to December 2003 were enrolled for this prospective study. The Judkins Left 3.5(JL3.5), the Multipurpose (MP) and Amplatz Left (AL2 for males, AL1 for females) were assigned to be used in patients with a randomized protocol. The technical/angiographic success rate, procedural/fluoroscopic time and the frequency of stiffwire usage were assessed. RESULTS: Technical success was accomplished in 87 (96.7%) of the patients with a single JL3.5, in 90 (97.8%) of the patients with the MP and in 83 (96.5%) of the patients with the AL catheter. Successful angiography success was achieved in 77 (85.6%) of the patients using the JL3.5, in 71 (77.2%) of the patients using the MP and in 66 patients (76.7%) using the AL. The technical success rate (p=0.270) and the angiographic success rate (p= 0.162) showed no significant difference among the three catheters. The procedural time was 8.1+/-4.0 min in the JL3.5 group, 8.1+/-3.7 min in the MP group and 7.3+/-3.4 min in the AL group, respectively (p=0.431). Also, the fluoroscopic time was not different among the three groups. CONCLUSION: The JL3.5 catheter is an excellent tool for both coronary imaging and it is equally successful as compared with the MP and AL catheters. Therefore, the JL3.5 may be considered as the initial catheter that can be used, including for those difficult cases having tortuous vasculature of the subclavian artery and the ascending aorta, during transradial coronary angiography.

Endoscopic Evaluation of Upper Gastrointestinal Injury in Patients with Noncaustic Drug Ingestion

PURPOSE: There have been few studies of the direct effect of a drug overdose on the gastrointestinal (GI) mucosa. This study evaluated the frequency of GI mucosal injury and the necessity for esophagogastroduodenoscopy (EGD) in patients with non-caustic drug ingestion (DI). METHODS: Patients who presented to the emergency department with non-caustic DI from January 2001 to December 2003 were enrolled in this study. EGD was performed on the patients after acute toxicologic management. Those who did not consent to EGD were excluded. The EGD findings were analyzed according to the non-caustic drug that had been ingested. RESULTS: Among the 37 patients, 24 (65%) had significant endoscopic lesions. Endoscopic findings were gastric erosion (n=17), ulcers (n=5), esophageal erosion (n=1), and a gastric hemorrhage (n=1). Pesticides, rodenticides, salicylates, and high dose doxylamine (>5 g) were associated with drug-induced gastropathy. CONCLUSION: This study suggests that GI mucosal injury has been underestimated in DI patients and that a treatment for gastromucosal protection should be performed when the non-caustic ingested drug is a pesticides, a rodenticides, a salicylates or high-dose doxylamine.

The Effectiveness of Carvedilol, a New Antioxidant and Antiproliferative Beta-Blocker, on Prevention of Restenosis after Coronary Stent Implantation: a Prospective, Randomized, Multicenter Study

BACKGROUND: Carvedilol is a direct inhibitor of vascular smooth muscle cell migration and proliferation through inhibition of mitogen-activated protein kinase activity and regulation of cell cycle progression. It produced an 84% suppression of neointimal hyperplasia in rat carotid angioplasty model, but no data are available regarding its effect on stent restenosis in patients. We tested whether a sustained oral administration of carvedilol reduces restenosis after coronary stenting in patients. METHODS: One hundred fifty nine patients were randomized to receive either carvedilol (50 mg/day, n=80) or atenolol (50 mg/day, n=79) at least 1 day before stenting and continued on the same medication over 3 months. The primary end point was angiographic restenosis (>50% diameter stenosis) at follow-up angiography. RESULTS: Baseline clinical and angiographic variables were similar between the carvedilol and atenolol group. The carvedilol dose was tolerable in most patients after adjustment of other medications, but reduced in 3 patients due to hypotension and dizziness. Angiographic follow-up was done in 137 patients (86%) and the restenosis rate was not different significantly between both groups (17.1% versus 19.4%, p=0.732). CONCLUSION: A sustained oral administration of carvedilol is not effective to reduce stent restenosis. With carvedilol targeting regulators of cell cycle progression and having a profound neointimal inhibition with a high blood concentration in an experiment, further investigations using a stent-based delivery to achieve a high local concentration may be warranted.

The Effect of Peripheral Pulse Arrival Time(PPAT) Measurement in Evaluating Endothelial Function: a Comparison with Flow-Mediated Vasodilation(FMD)

BACKGROUND AND OBJECTIVES: Endothelial dysfunction is an early change in the process of atherosclerosis. To evaluate endothelial function, expensive and specialized medical devices like high-resolution vascular ultrasound are necessary. Therefore, we sought to compare this atherosclerotic parameter of endothelial function using the inexpensive and simple method of peripheral pulse arrival time (PPAT) measurement. SUBJECTS AND METHODS: Before and after meals, we measured PPAT and flow-mediated vasodilation (FMD). Resting PPAT in both arms was measured with a PPAT device that was designed by the authors. Hyperemic effect was tested in both arms after raising the blood pressure to 250 mmHg for 5 minutes by using a blood pressure cuff, after which the cuff was released to 0 mmHg. PPAT was measured within the first 1 minute to observe the hyperemic response. FMD was measured in the same process by 7 MHz high-resolution ultrasound in the left brachial artery. The percent change was calculated from the baseline value and that of the hyperemic response. RESULTS: In low-fat diet, PPAT change was not different (3.8% vs. 4.7%, p>0.05). In high-fat diet, PPAT tended to be shorter, but without statistical significance (4.8% vs. 2.7%, p>0.05). In low-fat diet, the change of FMD was not different (11.7% vs. 11.4%, p>0.05). In high-fat diet, there was a significant difference in FMD (11.4% vs. 6.5%, p<0.05). CONCLUSION: The PPAT measurement could be a method for evaluating endothelial function, but is less sensitive than flow-mediated vasodilation.

A Case of Delayed Onset Tirofiban Induced Thrombocytopenia in a Chronic Renal Failure Patient

Compared with heparin induced thrombocytopenia (HIT), glycoprotein (GP) IIb/IIIa inhibitor induced thrombocytopenia is characterized by a rapid and profound fall in the platelet count. In severe cases, the platelet count decreases below 20,000/mm3 within the initial 24 hours after exposure to the drugs. It is often associated with severe bleeding complications. Tirofiban is one of the GP IIb/IIIa inhibitors. A case of severe thrombocytopenia in a 60-year-old man, with chronic renal failure (CRF) and acute myocardial infarction (AMI), was recently experienced. Tirofiban was administered to treat the AMI without ST segment elevation. The platelet count fell to 1,000/mm3 with hemoptysis and petechiae 80 hours after the initiation of tirofiban infusion. In this case, the clinical course was similar to that of the typical GP IIb/IIIa inhibitors induced thrombocytopenia, with the exception that its onset time was unusually delayed. The platelet count was normalized in 9 days after cessation of tirofiban infusion. Thus, this unusual case is reported as delayed onset tirofiban induced thrombocytopenia in a CRF patient.

Angiographic Outcomes and Predictors of Recurrent Restenosis after Cutting Balloon Angioplasty for the Treatment of In-Stent Restenosis

BACKGROUND AND OBJECTIVES: The optimal treatment for in-stent restenosis(SR) s controversial, although intracoronary radiation therapy(CRT) as provided the most consistent results to date. This study was designed to assess the early and late angiographic results, and to find independent predictors of recurrent restenosis, following cutting balloon angioplasty(BA) or ISR. SUBJECTS AND METHODS: Eighty patients(7 lesions) ith first time ISR underwent CBA and systematic follow-up(U) ngiography. A conventional balloon was used before, or after, the CBA, if required. ICRT was used in 18 lesions(1%). A multivariate logistic regression analysis was performed.(why?) RESULTS: he ISR was focal(n=2, 37%), diffuse or proliferative(n=1, 58%) nd occlusive(n=4, 5%). Procedural success was achieved in all 87 lesions(00%). No significant edge dissection occurred. The pre- and post-procedural diameter stenoses(S) ere 81.5+/-10.8% and 6.7+/-6.0%, respectively, and the pre- and post-procedural MLD(efine MLD?) .71+/-0.44 mm and 2.85+/-0.32mm, respectively, with 2.14+/-0.44mm of acute gain. A FU angiography was performed in 54(8%) f the 69 lesions treated with CBA alone. The overall angiographic restenosis rate was 24%(3/54), with 9%(/22) n the focal ISR and 34%(1/32) n the diffuse or occlusive ISR. The FU DS and MLD were 32.0+/-23.4% and 2.1+/-0.7mm, respectively, with 0.79+/-0.69mm of late loss. The length of a restenotic lesion(R 12.2, 95% CI:1.3-115.2, p=.0286) as an independent predictor of recurrent restenosis. CONCLUSION: CBA is a simple and efficient first line treatment for ISR, with an acceptable restenosis rate, and the length of a restenotic lesion is an independent predictor of recurrent restenosis. In diffuse or occlusive ISR, more definite treatment modalities, such as ICRT combined with CBA or debulking techniques, might be required to reduce recurrent restenosis.

Acute myocardial infarction accompanying occlusion of left anterior descending and right coronary arteries / 대한내과학회지

Acute myocardial infarction (AMI) with simultaneous occlusion of two or three coronary arteries is extremely rare, but may cause devastating events unless immediate revascularization strategies are undertaken. We report an unusual case of AMI with ST-segment elevation in precordial leads. Thrombolysis was achieved successfully 2 hours after the onset of chest pain. Coronary angiography revealed residual heavy fresh thrombi at right coronary artery (RCA) as well as patent residual stenosis at left anterior descending coronary artery (LAD). Akinesia was demonstrated at anterolateral, apical, diaphragmatic, and posterobasal segments on left ventriculography. Large perfusion defects were proven at LAD and RCA territories on myocardial SPECT.

Age and Gender Distribution of Patients with Acute Myocardial Infarction Admitted to University Hospitals during the Period of 1990-1999

BACKGROUND AND OBJECTIVES: The prevalence of coronary disease in Korea, with the consequent morbidity and mortality, has rapidly risen during the last two decades. This study aimed to describe the changing pattern in the demographic composition during the 1990s of patients presenting with acute myocardial infarction (AMI) in Korean metropolitan cities. SUBJECTS AND METHODS: Data from the medical record of patients with AMI, admitted to five University Hospitals in Busan and Daegu between January 1990 and December 1999, were sorted according to their age (75 years) and gender. RESULTS: During the last decade, the number of cases of AMI increased from 283 in 1990, to 988 by 1999 (ratio of AMI/medical patients admitted; 1.68% in 1990 to 2.52% in 1999). The most prevalent age group was 6074 yrs (46.1%), followed by 4559 yrs (34.2%). Generally, the male cases were twice as prevalent as female (68.2% : 31.8%), but the gender ratio was reversed in the highest age group (>75 yrs) (44.6% : 55.4%). During the period in question, the gender ratio and age distribution remained reasonably constant throughout. The proportion of younger AMI patients (<45 yrs) did not increase. CONCLUSION: Admissions due to AMI increased substantially during the 1990s. Almost half the cases were from the 6074 yrs age group, and two third were male. There were little changes in the compositions of age and gender of the AMI cases during this period.

The impact of preprocedural aminophylline administration on the development of bradyarrhythmias and hemodynamic changes during rotational atherectomy / 대한내과학회지

BACKGROUND: Rotational atherectomy or rotablation in right coronary artery (RCA) or dominant left circumflex artery (LCX) can cause bradyarrhythmias and requires the placement of prophylactic pacemaker. Adenosine is released endogenously by ischemic or hypoxic cells and mediates the bradyarrhythmias associated with impaired coronary flow. Aminophylline, an adenosine receptor antagonist, is known to prevent hypoxic bradyarrhythmias. The purpose of this study was to assess the impact of preprocedural aminophylline administration on the development of bradyarrhythmias and hemodynamic changes during rotablation. METHODS: High-speed rotablation was performed using a stepped burr approach in 38 patients following intravenous infusion of aminophylline (381.3+/-38.5 mg). The development of transient bradyarrhythmias and change of blood pressure and heart rate during the rotablation were assessed. RESULTS: Mean age was 56.9+/-8.8 years and 76% of the patients was male. Sixty-six percent of the patients has multivessel coronary artery disease and mean ejection fraction was 58%. Mean lesion length was 19.2+/-9.8 mm and RCA or dominant LCX lesions were 32 (84%). Mean burr/artery ratio was 0.61+/-0.05, maximum burr used was 1.69+/-0.16 mm, including 2.0 mm in 5 (13%) lesions, and mean ablation number was 6.4+/-2.8. Rotablation was successful without no reflow phenomenon in all patients. Low-pressure balloon angioplasty in all lesions and additional stenting in 24 (63%) lesions were followed. Neither severe discomfort nor serious arrhythmia occurred during the procedures. Systolic blood pressure and heart rate were not changed significantly before and after the aminophylline infusion, and during the rotablation (121.5+/-18.0 vs. 108.7+/-17.3 vs. 109.3+/-16.9 mmHg, p=0.062; 72.6+/-12.1 vs. 78.4+/-16.5 vs. 75.9+/-15.5 bpm, p=0.084, respectively). No bradyarrhythmias occurred during the rotablation with prior aminophylline infusion. Plasma aminophylline level measured after the procedure in 19 patients was 9.8+/-1.9 micro gram/mL. CONCLUSION: Preprocedural aminophylline administration may prevent the development of bradyarrhythmias during rotablation without significant hemodynamic changes. It seems a useful measure to obviate unfavorable pacing or even routine prophylactic placement of a pacemaker during the rotablation employing small burrs.

Modes of Cell Death and Survival in Cardiomyocytes Under Various Type of Ischemic Injury

BACKGROUND AND OBJECTIVES: The dominant mode of cell death in cardiomyocytes under acute ischemic insult, either necrosis or apoptosis, remains to be clearly shown. MATERIALS AND METHODS: Cultured neonatal rat ventricular myocytes (NRVM) were incubated under hypoxic (mixture gas of 95%N2/5%CO2 in glucose containing media), ischemic (hypoxia plus glucose depletion in the media), ischemic and acidic conditions (ischemia with media pH 7.1). The level of cell death was assessed by trypan blue staining. To differentiate the mode of cell death, genomic DNA extraction and electrophoresis, Annexin V/propodium iodide staining, western blot for caspase activation and transmission electron microscopy were employed. RESULTS: The number of cell deaths in the NRVM cultured under hypoxic conditions was similar to that of the controls. The rate of cell death was significantly increased in the NRVM cultured under ischemic conditions, and was accelerated further in an acidic milieu, which simulated the accumulation of metabolic byproducts in ischemia. No signs of apoptotic cell death were observed in the NRVM cultured under ischemic conditions. The morphological examination of the cells in ischemia mostly revealed necrotic death. CONCLUSION: The presence of glucose protected the cardiomyocytes from cell death under hypoxic conditions. Incubation of the NRVM in ischemia resulted in increased cell deaths, which was accelerated in an acidic milieu. In our model of acute ischemia, without reoxygenation, the cardiomyocyte cell deaths appeared to be primarily induced via necrosis rather than apoptosis.

Comparison of Tissue Perfusion Measured by ST Segment Resolution between Thrombolysis and Primary Stenting in Acute ST Elevation Myocardial Infarction

BACKGROUND AND OBJECTIVES: The primary objective of reperfusion therapy in the acute ST elevation myocardial infarction (STEMI) is the recovery of myocardial perfusion in infarct tissue, as well as the restoration of epicardial blood flow. ST segment resolution on the ECG is an index, which represents adequate myocardial tissue perfusion following treatment. SUBJECTS AND METHODS: Patients with acute STEMI, arriving within 12 hours of the onset of symptom underwent either thrombolysis (n=40) or primary stenting (n=51) were used for this study. ST segments on the ECG were measured with hand-held electronic callipers and the results were analysed by a single observer. RESULTS: Thrombolysis therapy was started earlier than primary stenting, although this was not statistically significant (311+/-171 minutes vs 399+/-251 minutes, p=0.61). After treatment, thrombolysis achieved a higher rate of complete ST segment resolution (>or=70%) compared to primary stenting (20/40;50.0% vs 13/51;25.4%, p=0.016). However, when the data was corrected for time, the difference between the two modalities was not significant (p=0.119). ST segment resolution varied significantly (p=0.026) according to treatment time, regardless of treatment modality. At the 6 month follow up, patients with complete ST segment resolution had a lower rate of major cardiac event (2.1% vs 13.8% p=0.094). CONCLUSION: In this study, thrombolysis achieved a higher rate of complete ST resolution compared with primary stenting in acute STEMI. By ad hoc analysis, this result was attributed to the difference in treatment time between the two groups, suggesting successful tissue reperfusion in acute STEMI is determined primarily by the rapidity, rather than the type, of treatment.

Heart Arrest Caused by Ergonovine Stress Echocardiography

Recent reports have suggested that ergonovine stress echocardiography is a safe and accurate procedure for the diagnosis of coronary vasospasm. We experienced a case of heart arrest caused by ergonovine stress echocardiography. A 44 year-old female patient was referred to our emergency room for evaluation of chest pain. She had been admitted to another hospital complaining of chest pain and syncope. The finding of a coronary angiogram was normal and an ergonovine stress echocardiography was performed in order to diagnose the coronary vasospasm, which may be an etiologic mechanism in an unstable angina. After 250 microgram of ergonovine was administered intravenously, we suspected segmental wall motion abnormality (hypokinesia of the inferior wall). An additional dose (100 microgram) was administered to confirm the diagnosis. The patient complained of severe chest pain and dizziness. Segmental wall motion abnormalities progressed and heart arrest finally developed. She recovered following cardiopulmonary resuscitation and was discharged without complication.

A case of stent insertion into stenotic renal artery caused by Takayasu's arteritis / 대한내과학회지

Takayasu's arteritis is a common etiology of renovascular hypertension in orientals. We report a case of renovascular hypertension caused by Takayasu's arteritis in a 18 year-old male patient. The narrowed renal artery was treated by renal artery stenting and blood pressure was normalized after the procedure. Restenosis was suspected after 7 months follow-up because his blood pressure was elevated.

Asymptomatic Cor Triatriatum in an Adult Incidentally Revealed by Echocardiography

We report an unusual case of asymptomatic cor triatriatum found in a 30-year-old female suffering form Bechect's syndrome. Cor triatriatum was suspected from a routine echocardiography. The left atrium was divided into a posterior superior chamber and an anterior inferior chamber (true left atrium) by an echo-dense membrane. Two turbulent jet flows were demonstrated on transesophageal echocardiography. Catheterization and angiography demonstrated a mild increase in the pulmonary artery, and capillary wedge, pressures no associated anomalies, and with four pulmonary veins draining into the posterior chamber. The membrane was successfully resected by surgery.

Four cases of ticlopidine-induced cholestatic hepatitis / 대한내과학회지

Ticlopidine, a potent antiplatelet agent, is widely used for treatment of coronary artery disease and cerebrovascular disease. Adverse effects has been reported in 10% to 20% of patients receiving ticlopidine. The most commom adverse effects were gastrointestinal disturbance, skin rash, but cholestatic hepatitis with jaundice was rare (0.1% incidence). We have recently experienced four cases of ticlopidine-induced cholestatic hepatitis after coronary artery stent insertion. Jaundice developed within 1 month of starting ticlopidine at recommended daily doses. In all cases, jaundice resolved and serum liver enzymes improved over a period of months after drug withdrawal. Therefore, clinicians should be aware of the reversible condition of ticlopidine-induced cholestatic jaundice that slowly resolves after drug withdrawal.

Usefulness of Ergonovine Echocardiography in Patients with Acute Coronary Syndrome and Suspected Variant angina

BACKGROUND AND OBJECTIVES: It is well known that coronary spasm can cause acute coronary syndrome (ACS) such as unstable angina or acute myocardial infarction as well as variant angina. But the role of coronary spasm as an initial presentation in ACS is difficult to demonstrate. Therefore we tried to investigate the validity and safety of ergonovine echocardiography in ACS with normal coronary angiogram (CAG) and suspected variant angina. MATERIALS AND METHOD: Since July 1999 to June 2000, 53 consecutive patients were enrolled for this study (mean age 56+/-10, 44 male). Clinical manifestations of the patients are acute myocardial infarction (8), unstable angina (17) and suspected variant angina (28). Ergonovine maleate was administered intravenously (50 microgram at 5 minute intervals up to total cumulative dosage 350 microgram) with continuous echocardiographic monitoring. Positive criteria of this test was reversible regional wall motion abnormality by echocardiography. RESULTS: This test was completed in all patients without major cardiac event or malignant arrhythmia. Forteen patients (14/53, 26%) showed positive test: their clinical diagnosis was AMI in 2, unstable angina in 6, and variant angina in 6. Four cases were positive without chest pain or electrocardiographic change. CONCLUSION: Ergonovine echocardiography is a safe and useful method in diagnosing coronary vasospasm in ACS with normal CAG and suspected variant angina without ST segment change.

Clinical Characteristics and Trends of the Surgical Treatment of Chordae Rupture

BACKGROUND AND OBJECTIVES: The proportion of mitral regurgitation caused by chordae rupture has recently been seen to be increasing, as has the role of mitral valve repair in the treatment of chordae rupture. This study evaluated the clinical characteristics and trends of surgical treatment of chordae rupture. Additionally, we attempted to discern the usefulness of transthoracic echocardiography (TTE) in the preoperative diagnosis of chordae rupture. SUBJECTS AND METHODS: Forty patients (20 men, mean age:49+/-14) presenting with chordae rupture confirmed during surgery between January 1994 and April 2001 were included in this study. Clinical, TTE and surgical data were analyzed retrospectively. RESULTS: The cause of chordae rupture was idiopathic degeneration in 28 cases, rheumatic heart disease in 5, infective endocarditis in 6, and trauma in 1 case. The sites of rupture were the anterior leaflet (14), posterior leaflet (23), and anterior and posterior leaflets (3). Mitral valve repair was performed in 20 cases and mitral valve replacement was performed in 20 cases. Most mitral valve repairs were performed beginning in 1998 (17/20). Chordae rupture diagnosed by TTE numbered 14 cases (35%). CONCLUSION: Regurgitation caused by chordae rupture was primarily associated with idiopathic degenerative change. Posterior leaflet rupture was more frequent than anterior leaflet rupture. The use of mitral valve repair has been increasing since 1998.