Comparison of Patients With and Without Papillary Muscle Rupture During Acute Myocardial Infarction

Figueras, Jaume; Calvo, Francisco; Cortadellas, Josefa; Soler‐Soler, Jordi

doi:10.1016/s0002-9149(97)00435-9

Cited by 28 publications

(18 citation statements)

References 10 publications

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“…5) Second, it has been reported that complete rupture is more common for the anterolateral papillary muscle, while partial rupture is more likely for the posteromedial papillary muscle. 2,6) The reason is considered to be that the anterolateral papillary muscle is generally a single mass of muscle tissue, while the posteromedial papillary muscle is formed from several smaller parts. Third, it has been reported that compared with other mechanical complications of myocardial infarction such as ventricular septal perforation or left ventricular free wall rupture, the extent of infarction is smaller, although subendocardial involvement is greater.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Single-branch lesions account for over half of the culprit coronary artery lesions and the right coronary artery is often involved. 3,6,7) Expeditious surgery for papillary muscle rupture is essential to save the patient. However, the early death rate after surgery for papillary muscle rupture remains very high at 19%-45%.…”

Section: Discussionmentioning

confidence: 99%

“…However, the early death rate after surgery for papillary muscle rupture remains very high at 19%-45%. 3,4,6,7) Several issues about surgery for these patients have been discussed. The first is whether to choose mitral valve replacement or valve plasty.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Complete Anterolateral Papillary Muscle Rupture Following Acute Myocardial Infarction

Doi

Nagura

Fukahara

et al. 2014

ATCS

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Complete Anterolateral Papillary Muscle Rupture Following Acute Myocardial Infarction

Doi

Nagura

Fukahara

et al. 2014

ATCS

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“…Rupture typically occurs within 5 days of the infarct. 1 It is postulated that the preserved contractility exerts increased stress on an already compromised papillary muscle, eventually leading to rupture. 2 This case highlights the importance of understanding mitral valve anatomy.…”

mentioning

confidence: 99%

Rupture of the Posteromedial Papillary Muscle Leading to Partial Flail of the Anterior Mitral Leaflet

Fradley

Picard

2011

Circulation

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A n 86-year-old woman with a history of hypertension presented with acute onset of chest pain and evidence of shock (hypotension and tachycardia). For the preceding 2 weeks, she had been experiencing intermittent nausea and vomiting; proton pump inhibitors did not improve her symptoms. The ECG showed ST elevations in the inferior leads and ST depressions in leads V 1 and V 2 , with reciprocal ST depressions in leads I and aVL, suggesting an acute inferoposterior infarction (Figure 1). Physical examination also revealed a new 2/6 holosystolic murmur at the apex and significant bilateral rales. She was taken emergently to the cardiac catheterization laboratory, where 100% thrombotic occlusion of the middle right coronary artery was revealed ( Figure 2A). A left ventriculogram revealed severe (4ϩ) mitral regurgitation with a normal-sized left atrium ( Figure 2B). An intra-aortic balloon pump was placed, and she was transferred to the cardiac intensive care unit. A transthoracic echocardiogram revealed normal right and left ventricular size and function, with evidence of inferior and posterior wall hypokinesis. The estimated pulmonary artery systolic pressure was significantly elevated at 77 mm Hg. Most important, however, the echocardiogram confirmed both severe mitral regurgitation with rupture of the posteromedial papillary muscle and partial flail of the anterior mitral leaflet (Figure 3A through D; Movies I through III in the online-only Data Supplement). Unfortunately the patient's clinical status continued to worsen. She was deemed extremely high risk for surgery, and her healthcare proxy confirmed her do-notresuscitate/do-not-intubate status. She expired several hours later despite maximal hemodynamic support.Acute mitral regurgitation caused by papillary muscle rupture is a rare but life-threatening complication of myocardial infarction. Patients typically present with an inferior infarction with the right coronary artery as the culprit. They also tend to be older and have a preserved ejection fraction. Rupture typically occurs within 5 days of the infarct. 1 It is postulated that the preserved contractility exerts increased stress on an already compromised papillary muscle, eventually leading to rupture. 2 This case highlights the importance of understanding mitral valve anatomy. The valve itself comprises an anterior and a posterior leaflet. Valvular competence is maintained by

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“…The predominant involvement of posteromedial papillary muscle in patients with inferior acute myocardial infarction in the location of papillary muscle rupture is due to a predominantly single blood supply 8 . Nevertheless the association of papillary muscle rupture with left circumflex coronary artery occlusion has been also demonstrated 9 . A high index of suspicion is the key to an early diagnosis and the specific management of a hemodynamically compromised patient with specific mechanical complication of acute myocardial infarction.…”

mentioning

confidence: 99%

Acute Severe Mitral Regurgitation With Cardiogenic Shock Caused by Two-Step Complete Anterior Papillary Muscle Rupture During Acute Myocardial Infarction

Hutyra¹,

Škála²,

Marek³

et al. 2006

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background: Rupture of a papillary muscle is an infrequent but often fatal mechanical complication of acute myocardial infarction.Aim: The aim of this paper is to present a case report of a 65-year old women with acute severe mitral regurgitation with cardiogenic shock caused by two-step complete anterior papillary muscle rupture during acute myocardial infarction. The transthoracic echocardiography was obtained at the bedside and showed a posterior mitral valve prolapse with a severe mitral regurgitation. During this examination the patient developed acute pulmonary oedema and a consequent cardiogenic shock. Transthoracic echocardiography was then reevaluated and completed. New findings of bi-leaflet mitral flail and progression of massive mitral regurgitation were documented. The complete rupture of a papilary muscle was then considered as a cause of an acute clinical deterioration. Intraoperative findings showed a complete transection of both heads of anterolateral and necrotic regions of basis of posteromedial papillary muscle.Conclusions: This case confirms the importance of immediate echocardiography in confirming a diagnosis of acute mechanical complications of acute coronary syndromes and this examination is important for the management of a hemodynamically unstable patient. Echocardiography should be done immediately on any patient in whom the diagnosis of mechanical complication of acute coronary syndromes is suspected. BACKGROUND

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Comparison of Patients With and Without Papillary Muscle Rupture During Acute Myocardial Infarction

Cited by 28 publications

References 10 publications

Surgical Treatment of Complete Anterolateral Papillary Muscle Rupture Following Acute Myocardial Infarction

Surgical Treatment of Complete Anterolateral Papillary Muscle Rupture Following Acute Myocardial Infarction

Rupture of the Posteromedial Papillary Muscle Leading to Partial Flail of the Anterior Mitral Leaflet

Acute Severe Mitral Regurgitation With Cardiogenic Shock Caused by Two-Step Complete Anterior Papillary Muscle Rupture During Acute Myocardial Infarction

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