Work

Thyrotoxicosis-Induced Chordal Rupture Causing Severe Mitral Regurgitation

Year: 2025

Type: article

Abstract: BACKGROUND: Thyrotoxicosis often causes tachyarrhythmias and high-output states but rarely results in structural valvular failure. CASE SUMMARY: A 57-year-old man with new-onset thyrotoxicosis presented with atrial fibrillation and torrential mitral regurgitation from a flail anterior leaflet from chordal rupture. After stabilization with methimazole and β-blockade, he underwent mitral valve replacement with a 33-mm porcine bioprosthesis, as extensive leaflet and chordal damage precluded durable repair. Postoperatively, transient left ventricular dysfunction improved with medical therapy. Sinus rhythm was maintained on downtitrated amiodarone, and anticoagulation with apixaban was selected after shared decision-making for atrial fibrillation management. DISCUSSION: This case underscores the structural impact of thyrotoxicosis on valvular tissue, through hyperdynamic stress and matrix remodeling. Preoperative endocrine optimization and intraoperative storm prevention are critical. TAKE-HOME MESSAGES: Thyrotoxicosis can cause chordal rupture and flail leaflet. Repair is preferred, but replacement is appropriate when repair is not durable. Management requires endocrine-cardiac coordination and individualized antithrombotic therapy. Expect early ejection-fraction decline after surgical correction.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106426

Authors: Rohit Pandit, Ahmed Abu-haniyeh, Aws Polina, Bezawit Zewde, Gajendra Acharya

Institution: Maryland Geological Survey

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850