MR caused by chordal elongation or rupture corresponds to which Carpentier type?

• A. Type I
• B. Type IIIa
• C. Type II
• D. Type IIIb

Answer: (C)

Chordae tendineae that are elongated or ruptured allow the mitral leaflets to move excessively into the left atrium during systole, producing prolapse or a flail leaflet. In Carpentier’s system this pattern of excessive leaflet motion is Type II. By contrast, other types describe different motion patterns: normal leaflet motion with MR from annular dilation (Type I); restricted motion of both leaflets (often rheumatic disease) (Type IIIa); or restricted motion during systole due to tethering from ischemia (Type IIIb). So chordal elongation or rupture causing prolapse aligns with Type II because the core issue is too much leaflet mobility. On ultrasound, you’d expect to see a prolapsed or flail leaflet with an eccentric MR jet.