CHORDAE & PAPILLARY MUSCLES REPAIR - Overview, Facts, & Etc. .
CHORDAE & PAPILLARY MUSCLES

CHORDAE & PAPILLARY MUSCLES REPAIR

Chordae & papillary muscles repair are found in the human heart which play an essential role in the primary function of it. The papillary muscles can be found in the contractile portion of the heart known as ventricles. These ventricles are responsible for exerting the pressure needed to eject the blood from the heart, and they comprise approximately 10 % of the total weight of the heart.

The chordae tendineae originate from the papillary muscles and are primarily responsible for the prevention of the prolapse of the valves of the heart. These valves are divided into two or three leaflets which function to close off the chamber to prevent reflux of blood. The chordae tendinae is also responsible for maintaining the structural integrity of the ventricles. 

These two structures, because of their location, are prone to injury that may be caused by blunt chest trauma and heart attack.

TYPES

Any of the following mechanisms may injure chordae & papillary muscles repair :

  1. Blunt chest trauma
  2. Calcification of the chordae tendineae as manifested by Advanced Barlow’s disease leading to restriction of the motion of the valve leaflets
  3. Displacement of the papillary muscles due to chronic enlargement of the ventricles as what occurs in dilated cardiomyopathy.    

SYMPTOMS

Symptoms of injury to the chordae tendineae includes:

  1. Presence of a loud murmur (abnormality on auscultation), usually accompanying the systolic beat of the heart. The most common location is at the apex, and the 2nd left intercostal space near the sternal border.
  2. On physical examination, there is the appearance of a thrill. This is otherwise termed as a palpable murmur. The clinician places his/her palm over the area of the defective valve, and the murmur or rumbling can be felt on his palm. 
  3. Ventricular fibrillation can occasionally be seen. This is a condition where the heart trembles instead of the usual contraction to expel blood. This is a life-threatening symptom of chordae and papillary rupture which needs to be addressed immediately.

DIAGNOSIS

  1. Imaging studies such as two-dimensional echocardiography and routine chest X-ray examinations can visualize cardiac changes such as enlargement of the cardiac shadow and segmental wall motion abnormalities in cases of papillary rupture.
  2. The fluoroscopic examination involves the installation of a dye, either intravenously or orally. After, the patient is subjected to perform a series of radiologic imaging to detect or identify the exact location of the pathology.


TREATMENT

  1. Injury of the papillary muscles is treated using the replacement of the valve involved, most commonly the mitral valve. 
  2. Free wall injury is treated by removal and closure of the area whose blood supply is cut off. The closure is done by use of patches made of Teflon or by use of biologic glues.
  3. Defect involving the portion that divides the ventricles to both left and right is done by the use of a patch and suturing it in place. 
  4. CABG or coronary artery bypass surgery is the most common treatment among patients who suffered papillary muscle and chordae rupture due to a heart attack.
  5. Pharmacologic therapy is also an option among individuals who have a high surgical risk, including those patients who have been using oral anticoagulants for an extended period since they have a high likelihood of bleeding postoperatively.

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