WordNet

state of being torn or burst open
the act of making a sudden noisy break
a personal or social separation (as between opposing factions); "they hoped to avoid a break in relations" (同)breach, break, severance, rift, falling out
play chords on (a string instrument)
a straight line connecting two points on a curve
a combination of three or more notes that blend harmoniously when sounded together

PrepTutorEJDIC

〈U〉〈C〉(…の)破裂《+『of』+『名』》 / 〈U〉〈C〉(友好的関係などの)決裂,仲たがい / 〈C〉裂け目 / 〈C〉脱腸,ヘルニア / …‘を'破裂させる / 〈友好関係など〉‘を'断ち切る / 破裂する
《所有・所属》…『の』,…のものである,…に属する・《材料・要素》…『でできた』,から成る・《部分》…『の』[『中の』] ・《数量・単位・種類を表す名詞に付いて》…の・《原因・動機》…『で』,のために(because of) ・《主格関係》…『の』,による,によって・《目的格関係》…『を』,の・《同格関係》…『という』・《関係・関連》…『についての』[『の』],の点で・《抽象名詞などと共に》…の[性質をもつ] ・《『It is』+『形』+『of』+『名』+『to』 doの形で,ofの後の名詞を意味上の主語として》・《分離》…『から』・《起原・出所》…『から』[『の』](out of) ・《『名』+『of』+『a』(『an』)+『名』の形で》…のような・《『名』+『of』+『mine』(『yours, his』など独立所有格)の形で》…の…・《時》(1)《副詞句を作って》…に《形容詞句を作って》…の・《時刻》《米》…前(to,《米》before)
(楽器の)弦 / 感情,情緒 / 和音,コード / =cord4 / 弦(数学で,円周上の2点を結ぶ直線)
OLD French古[代]フランス語

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/24 17:48:33」(JST)

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Myocardial rupture (or heart rupture) is a laceration or tearing of the walls of the ventricles or atria of the heart, of the interatrial or interventricular septum, of the papillary muscles or chordae tendineae or of one of the valves of the heart. It is most commonly seen as a serious sequela of an acute myocardial infarction (heart attack).

It can also be caused by trauma.^[1]

Etiology

The most common cause of myocardial rupture is a recent myocardial infarction, with the rupture typically occurring three to five days after infarction.^[2] Other causes of rupture include cardiac trauma, endocarditis (infection of the heart),^[3]^[4] cardiac tumors, infiltrative diseases of the heart,^[3] and aortic dissection.^{[citation needed]}

Risk factors for rupture after an acute myocardial infarction include female gender,^[5]^[6] advanced age of the individual,^[5]^[6] and a low body mass index.^[5] Other presenting signs associated with myocardial rupture include a pericardial friction rub, sluggish flow in the coronary artery after it is opened i.e. revascularized with an angioplasty, the left anterior descending artery being often the cause of the acute MI,^[5]^[6]^[7] and delay of revascularization greater than 2 hours.^[6]

Incidence

The incidence of myocardial rupture has decreased in the era of urgent revascularization and aggressive pharmacological therapy for the treatment of an acute myocardial infarction. However, the decrease in the incidence of myocardial rupture is not uniform; there is a slight increase in the incidence of rupture if thrombolytic agents are used to abort a myocardial infarction.^[8] On the other hand, if primary percutaneous coronary intervention is performed to abort the infarction, the incidence of rupture is significantly lowered.^[6] The incidence of myocardial rupture if PCI is performed in the setting of an acute myocardial infarction is about 1 percent.^[5]

Classification

Myocardial ruptures can be classified as one of three types.

Type I myocardial rupture is an abrupt slit-like tear that generally occurs within 24 hours of an acute myocardial infarction.
Type II is an erosion of the infarcted myocardium, which is suggestive of a slow tear of the dead myocardium. Type II ruptures typically occur more than 24 hours after the infarction occurred.
Type III ruptures are characterized by early aneurysm formation and subsequent rupture of the aneurysm.^[9]

Another method for classifying myocardial ruptures is by the anatomical portion of the heart that has ruptured. By far the most dramatic is rupture of the free wall of the left or right ventricles, as this is associated with immediate hemodynamic collapse and death secondary to acute pericardial tamponade. Rupture of the interventricular septum will cause a ventricular septal defect. Rupture of a papillary muscle will cause acute mitral regurgitation.

Signs and symptoms

Symptoms of myocardial rupture are recurrent or persistent chest pain, syncope, and distension of jugular vein.

Diagnosis

Due to the acute hemodynamic deterioration associated with myocardial rupture, the diagnosis is generally made based on physical examination, changes in the vital signs, and clinical suspicion. The diagnosis can be confirmed with echocardiography.

Treatment

The treatment for myocardial rupture is supportive in the immediate setting and surgical correction of the rupture, if feasible.^{[citation needed]} A certain small percentage of individuals do not seek medical attention in the acute setting and survive to see the physician days or weeks later. In this setting, it may be reasonable to treat the rupture medically and delay or avoid surgery completely, depending on the individual's comorbid medical issues.

Prognosis

The prognosis of myocardial rupture is dependent on a number of factors, including which portion of the myocardium is involved in the rupture. In one case series, if myocardial rupture involved the free wall of the left ventricle, the mortality rate was 100.0%.^[5] Even if the individual survives the initial hemodynamic sequelae of the rupture, the 30 day mortality is still significantly higher than if rupture did not occur.^[5]

References

^ Nan YY, Lu MS, Liu KS, et al. (September 2009). "Blunt traumatic cardiac rupture: therapeutic options and outcomes". Injury 40 (9): 938–45. doi:10.1016/j.injury.2009.05.016. PMID 19540491.
^ Figueras J, Alcalde O, Barrabes JA, Serra V, Alguersuari J, Cortadellas J, et al. Changes in Hospital Mortality Rates in 425 Patients with Acute ST-Elevation Myocardial Infarction and Cardiac Rupure Over a 30-Year Period. Circulation. 2008;118:2783–9.
^ ^a ^b Lin TH, Su HM, Voon WC, Lai HM, Yen HW, Lai WT, Sheu SH. (2006). "Association between hypertension and primary mitral chordae tendinae rupture.". Am J Hypertens 19 (1): 75–9. doi:10.1016/j.amjhyper.2005.06.020. PMID 16461195.
^ de Diego C, Marcos-Alberca P, Pai RK. (2006). "Giant periprosthetic vegetation associated with pseudoaneurysmal-like rupture." (PDF). Eur Heart J 27 (8): 912. doi:10.1093/eurheartj/ehi540. PMID 16569654.
^ ^a ^b ^c ^d ^e ^f ^g Yip HK, Wu CJ, Chang HW, Wang CP, Cheng CI, Chua S, Chen MC. (2003). "Cardiac rupture complicating acute myocardial infarction in the direct percutaneous coronary intervention reperfusion era." (PDF). Chest 124 (2): 565–71. doi:10.1378/chest.124.2.565. PMID 12907544.
^ ^a ^b ^c ^d ^e Moreno R, Lopez-Sendon J, Garcia E, Perez de Isla L, Lopez de Sa E, Ortega A, Moreno M, Rubio R, Soriano J, Abeytua M, Garcia-Fernandez MA. (2002). "Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction.". J Am Coll Cardiol 39 (4): 598–603. doi:10.1016/S0735-1097(01)01796-X. PMID 11849857.
^ Sugiura T, Nagahama Y, Nakamura S, Kudo Y, Yamasaki F, Iwasaka T. (2003). "Left ventricular free wall rupture after reperfusion therapy for acute myocardial infarction.". Am J Cardiol 92 (3): 282–4. doi:10.1016/S0002-9149(03)00625-8. PMID 12888132.
^ Becker RC, Gore JM, Lambrew C, Weaver WD, Rubison RM, French WJ, Tiefenbrunn AJ, Bowlby LJ, Rogers WJ. (1996). "A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction.". J Am Coll Cardiol 27 (6): 1321–6. doi:10.1016/0735-1097(96)00008-3. PMID 8626938.
^ Becker AE, van Mantgem JP. (1975). "Cardiac tamponade. A study of 50 hearts.". Eur J Cardiol 3 (4): 349–58. PMID 1193118.

UpToDate Contents

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1. 急性僧帽弁閉鎖不全症の病態生理、臨床的特徴、評価、およびマネージメント pathophysiology clinical features evaluation and management of acute mitral regurgitation
2. 僧帽弁逸脱の非不整脈合併症 nonarrhythmic complications of mitral valve prolapse
3. 僧帽弁疾患の評価における経食道心エコー transesophageal echocardiography in the evaluation of mitral valve disease
4. 慢性僧帽弁閉鎖不全の病因、臨床的特徴、および評価 etiology clinical features and evaluation of chronic mitral regurgitation
5. 僧帽弁逸脱および僧帽弁尖動揺における慢性僧帽弁閉鎖不全症の自然史 natural history of chronic mitral regurgitation in mitral valve prolapse and flail mitral leaflet

English Journal

Tissue-engineered mitral valve chordae tendineae: Biomechanical and biological characterization of decellularized porcine chordae.

Gong W1, Li S1, Lei D2, Huang P2, Yuan Z1, You Z2, Ye X3, Zhao Q4.
Journal of the mechanical behavior of biomedical materials.J Mech Behav Biomed Mater.2016 Mar;56:205-17. doi: 10.1016/j.jmbbm.2015.11.008. Epub 2015 Nov 23.
Chordae tendineae are essential for maintaining mitral valve function. Chordae replacement is one of the valve repair procedures commonly used to treat mitral valve regurgitation. But current chordae alternatives (polytetrafluoroethylene, ePTFE) do not have the elastic and self-regenerative properti
PMID 26708255

Morphological and mechanical properties of the posterior leaflet chordae tendineae in the mitral valve.

Lodder J1, Verkerke GJ2, Delemarre BJ3, Dodou D4.
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.Proc Inst Mech Eng H.2016 Feb;230(2):77-84. doi: 10.1177/0954411915621093. Epub 2015 Dec 7.
A number of studies have investigated the morphological and mechanical properties of the chordae tendineae of the mitral valve, providing comparisons between basal, marginal, and strut chordae and between chordae at the anterior and posterior leaflets. This study contributes to the literature by com
PMID 26645804

Mass attached to mechanical mitral valve mimicking a thrombus.

Calvo-Taracido M1, Bustamante S2, Adasme Ó2, Kara S2, Merino J2, Pivetta R2, Macedo M2, Marrero R2, Fernández R2, Puccio JM2.
International journal of cardiology.Int J Cardiol.2015 Dec 15;201:210-1. doi: 10.1016/j.ijcard.2015.06.116. Epub 2015 Jul 21.
Mitral valve replacement with preservation of chordae tendineae and papillary muscles is a well-known technique which has proved beneficial by reducing postoperative left ventricular remodeling and preserving left ventricular function. This advantage has been demonstrated in functional mitral valve
PMID 26298382

Japanese Journal

けいれん, DIC, 手指壊疽性変化, 僧帽弁腱索断裂, 一過性冠動脈病変合併の重症川崎病の1乳児例

石川順一,鹿間芳明,赤城邦彦
小児感染免疫 24(2), 163-170, 2012-07-01
NAID 10030801433

Rupture of the Tricuspid Valve due to Smashing the Chest into the Steering Wheel

Aykut Koray,Kaya Murat,Acﾄｱkel Unal
Annals of
… The completely flail anterior leaflet, due to the rupture of the papillary muscles, was revealed by a two-dimensional transthoracic echocardiography. … In the operation, we also detected a tear on the anterior leaflet and the rupture of numerous chordae tendineae of the other leaflets. …
NAID 130002583904

Comparison of the Diagnostic Power of Transthoracic and Transesophageal Echocardiography to Detect Ruptured Chordae Tendineae

Minami Takako,Kawano Hiroaki,Yamachika Shiro,Tsuneto Akira,Kaneko Masayuki,Kawano Yasuko,Minami Shigeki,Eishi Kiyoyuki,Maemura Koji
International Heart Journal 53(4), 225-229, 2012
… Preoperative information concerning the severity and etiology of MR is very important for selecting the most appropriate surgical strategy. … Ruptured chordae tendineae (RCT) are one of the most important preoperative findings. … We compared the diagnostic power of transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) to detect RCT in patients with MR. We studied 61 patients with MR (30 men, 31 women; …
NAID 130001914151