Case Report
Spontaneous chordae tendineae rupture during peripartum

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Abstract

Acute cardiopulmonary distress in pregnancy always carries exceptionally arduous challenge for physicians. Here we report a patient who sustained spontaneous chordae tendineae rupture complicated with severe mitral regurgitation and acute pulmonary edema during peripartum period. Probable causes of chordae tendineae rupture include mitral valve prolapse, infectious endocarditis, congenital heart disease, rheumatic heart disease, ischemic heart disease, connective tissue diseases, previous mitral valve surgery or pregnancy itself. The pathophysiology of spontaneous chordae tendineae rupture due to pregnancy remains unclear. However, certain physiological stress, including hormone changes related matrix remodeling, increased cardiac output during pregnancy or labor pain may precipitate to this condition. Literature reviews from previously reported cases showed that those who were diagnosed chordae tendineae rupture at very preterm period all had preterm delivery.

Introduction

Acute cardiopulmonary distress in pregnancy is always challenging for physicians and requires multidisciplinary team approach. Early recognition of the underlying cause and timely treatment are the keys. We described a case of sudden appearance of severe mitral regurgitation in an otherwise normal peripartum patient that gave rise to acute pulmonary edema. We suggested that bedside echocardiography is the cornerstone of rapid diagnosis of chordae tendineae rupture.

Section snippets

Case report

A 31-year-old healthy pregnant woman, gravida 1, para 0, presented to the emergency department at 32 weeks and 5 days of gestation, with complaint of shortness of breath 1 day prior to spontaneous preterm delivery at a clinic. She did not have fever or cough. On arrival, her pulse rate was 126 bpm, blood pressure 135/96 mm Hg, respiratory rate of 27 per minute, and oxygen saturation 86% on 10 L per minute oxygen mask. Her physical examination was notable for rales over bilateral lungs, presence of a

Discussion

Acute cardiopulmonary distress in pregnancy may result from devastating causes such as preeclampsia, amniotic fluid embolism, pulmonary embolism, peripartum cardiomyopathy, myocardial infarction or even acute aortic dissection [1]. Acute pulmonary edema is a rare event during pregnancy and can arise from different etiologies such as preeclampsia, tocolytics use, iatrogenic volume overload and cardiac disease. Physiological changes in pregnancy make pregnant women susceptible to pulmonary edema [

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© 2018 Published by Elsevier Inc.