Adult Echocardiography Practice Exam

Spontaneous chordal rupture most often occurs with the:

1. posterior leaflet

2. anterior leaflet

3. septal leaflet

4. affects both the same

The correct answer is: posterior leaflet

Spontaneous chordal rupture is predominantly associated with the posterior leaflet of the mitral valve. This condition often occurs in individuals with pre-existing degenerative changes in the mitral valve, such as myxomatous degeneration. These changes weaken the mitral valve's structure and predispose the chordae tendineae, which are the fibrous cords connecting the papillary muscles to the valve leaflets, to rupture. The posterior leaflet of the mitral valve is more susceptible due to its unique anatomical and mechanical properties. It experiences significant stresses during the heart's filling (diastole) and contraction (systole), causing the chordae to be under continuous strain. In degenerative conditions, this strain can lead to a failure of the chordal support specifically associated with the posterior leaflet, resulting in rapid deterioration of mitral valve function and the potential for severe mitral regurgitation. The anterior leaflet, while significant in its function and also can be involved in chordal rupture, does not experience the same degree of mechanical pressure or structural vulnerability as the posterior leaflet, making it less common for spontaneous ruptures to originate there. The septal leaflet, part of the tricuspid valve in the context of the right heart, is not typically