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In such patients, the interventricular defect is usually small, and shunting is limited by tendinous cords tethering the bridging leaflets.
In the most severe cases, the free edges of the leaflets are adherent to the subvalvar muscle with no intervening tendinous cords.
Note the tendinous cords from the tricuspid valve connecting to a single papillary muscle.
This had a large flat abnormal posterolateral papillary muscle an abnormal insertion of the tendinous cords.
At surgery, one of the six patients with a diagnosis of rupture was found to have only elongation of the tendinous cords.
Opened tricuspid valve showing shortened tendinous cords, but no formation of a muscular arcade.
The tendinous cords are implanted on the subvalvar muscle and, in consequence, their insertion is more posterior and higher than normal.
The tendinous cords of the septal leaflet were lengthened by interposing a short segment of 4-0 expanded polytetrafluoroethylene suture.
The tricuspid valve is diffusely thickened with fusion of the commissures and fused and shortened tendinous cords.
The septal leaflet is often poorly developed, with short or absent tendinous cords.
Defects of the aortic leaflet are treated by patching with pericardium provided that the free edge is adequatly supported by tendinous cords.
The tendinous cords of the tricuspid valve were also abnormal, a finding, to the best of our knowledge, not reported before.
At surgery, rupture of the tendinous cords supporting the aortic leaflet of the mitral valve was found in three patients.
The chronically injured valves are characterized by thickening and calcification of their leaflets, commissural adhesions, and shortening and adherence of the tendinous cords.
Rupture of the tendinous cords in severe acute rheumatic fever is probably not very rare, but this finding has rarely been corroborated.
