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Chordae tendineae rupture is a rare but significant cause of acute or progressive mitral regurgitation (MR), often related to underlying mitral valve prolapse (MVP) [1-4]. Early diagnosis and timely surgical intervention are essential to avoid irreversible cardiac dysfunction [1,5]. We report two cases of chordae rupture leading to severe MR with distinct clinical courses. The first patient, a 56-year-old male with MVP, presented acutely with atrial fibrillation, pulmonary symptoms, and was found to have a flail posterior leaflet with severe MR. He underwent successful minimally invasive mitral and tricuspid valve repair with cryoablation and LAA closure. The second patient, a 47-year-old male with no prior comorbidities, presented with progressive dyspnoea and chest discomfort and was found to have severe MR due to PML prolapse with suspected chordae rupture, moderate LV dysfunction, and pulmonary hypertension. He was referred for surgical intervention. These cases highlight the spectrum of clinical manifestations of MR due to chordal rupture and the importance of echocardiographic assessment and timely referral for surgical management [2,6,13].

Keywords: Mitral valve; Echocardiography; Chordae tendineae rupture; Mitral regurgitation; Flail leaflet; Heart failure