case_images: PMC4531682_01
case_images: The bang-down mid-esophageal long-axis view (A) and four-chamber view (B) shows anterior mitral valve prolapse (arrow) into the left atrium during systole. (ANT, anterior wall; LV, left ventricle; LA, left atrium; RV, right ventricle)
case_images: kjim-17-4-274-13f1.jpg
case_images: PMC4531682_01_kjim-17-4-274-13f1.jpg
case_images: f1-kjim-17-4-274-13
case_images: III/IV mitral regurgitation with anterior mitral leaflet prolapse was identified (Figure 1A). In mid-esophageal four-chamber view, flail motion of anterior mitral valve leaflet was visualized which was highly suspicious of the ruptured chordae tendinae (Figure 1B). In transgastric two-chamber view, we could identify the ruptured head of papillary muscle as a separated mobile mass attached to chordae tendinae of anterior mitral valve leaflet and the stump of the ruptured posteromedial papillary muscle (Figure 2A, 2B).
case_images: The bang-down transgastric long-axis view clearly shows flail motion of the ruptured stump (double arrows) and the head (arrow) of the posteromedial papillary muscle during diastole (A). During systole, the two ruptured parts approach each other (B). (ANT, anterior wall; LV, left ventricle; LA, left atrium)
case_images: kjim-17-4-274-13f2.jpg
case_images: PMC4531682_01_kjim-17-4-274-13f2.jpg
case_images: f2-kjim-17-4-274-13
case_images: In mid-esophageal four-chamber view, flail motion of anterior mitral valve leaflet was visualized which was highly suspicious of the ruptured chordae tendinae (Figure 1B). In transgastric two-chamber view, we could identify the ruptured head of papillary muscle as a separated mobile mass attached to chordae tendinae of anterior mitral valve leaflet and the stump of the ruptured posteromedial papillary muscle (Figure 2A, 2B). During diastole, the two ruptured parts moved freely within the left ventricular cavity but, during systole, each ruptured end of the papillary muscle parts approaced each other and we could clearly visualize the stump of the ruptured posteromedial papillary muscle within the left ventricle (Figure 2A, 2B).