6.4.3 Further diagnostic aids
Echocardiographic examination is required to confirm the presence of ruptured chordae tendineae ante-mortem. The affected valve leaflet may be seen to flail into the atrium. If the plane of the beam is in the long axis of the affected valve, this appears as a curve of the leaflet into the atrium during systole (Figure 4.23). If the plane of the beam is not aligned with the valve, a flash of an echogenic dot may be seen in the atrium, just behind the valve. Often, careful examination from the right and left parasternal positions is required in order to identify the abnormal motion. Flail due to rupture of the right commissural cusp chordae tendineae is usually best seen in a left parasternal long-axis view.
At PM, a ruptured chorda may be difficult to find without careful inspection (Figure 2.2). Usually a tag will be present where the chorda originates on the papillary muscle, while a curled-up piece of tissue is found on the ventricular side of the leaflet where it inserts. Jet lesions may be seen in the atrium (Figure 2.1).