Aortic Chordae Tendineae Strands with Significant Aortic Regurgitation

Abstract

The aortic chordae tendineae strands are suggested to be embryonic remnants of the cusp formation process. We herein describe a 70-year-old male who was admitted to our hospital for shortness of breath and chest tightness. During echocardiographic examination, severe aortic regurgitation with a ruptured fibrous strand was detected. Moreover, another fibrous strand was found by three-dimensional transesophageal echocardiography (TEE). To our knowledge, this is the first literature review of aortic chordae tendineae strands, including diagnosis, management, and mechanisms of aortic regurgitation due to such informal strands.

The extremely rare case of aortic chordae tendineae strands: A case report with literature review

“…Patients with unexplained AR should undergo a thorough evaluation for ACTS, which TEE more easily observes than TTE. 1 Additionally, three-dimensional TEE plays a significant role in making a diagnosis. 7 In our patient both TTE and TEE echocardiograms were performed, and both revealed abnormal lines in the aortic valve.…”

“…However, the medical history of our patient and the normality of inflammatory factors did not support the diagnosis of a noninfectious neoplasm. 1 Most patients with severe AR will need aortic valve replacement (AVR). An aortic valve repair is only an option for patients whose anatomy is suitable (aortic dilation without a thickened, deformed, or calcified valve).…”

“…AVR is, therefore, the primary treatment for AR caused by ACTS. 1 Only 19 cases of ACTS have been reported since 1984, 15 of which were in men and four in women. The average age of reported cases was 55.85 ± 17.58 years, and the majority of patients presented with dyspnea.…”

“…The aortic chordae tendineae strands (ACTS), also known as “fibrous strands” in the literature, are believed to be embryonic remnants of the process of cusp formation. Rarely have ACTS on bicuspid and tricuspid aortic valves (AV) caused spontaneous aortic regurgitation (AR) 1,2 . In this study, we present the case of a patient with tricuspid AV with normal thickening and ACTS.…”

Acute aortic regurgitation due to fibrous strand rupture

“…1 Several case reports have described aortic regurgitation associated with chordae tendineae due to leaflet restriction and valve tenting following aortic dilatation. [2][3][4] Here, we describe rupture of a fibrous strand present as a supporting structure of the aortic valve, resulting in acute loss of aortic leaflet support and subsequent torrential aortic regurgitation.…”