Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction

Tanimoto, Takashi; Imanishi, Toshio; Kitabata, Hironori; Nakamura, Nobuo; Kimura, Keizo; Yamano, Takashi; Ishibashi, Keiichiro; Komukai, Kenichi; Ino, Yasushi; Takarada, Shigeho; Kubo, Takashi; Hirata, Kumiko; Mizukoshi, Masato; Tanaka, Atsushi; Akasaka, Takashi

doi:10.1161/circulationaha.109.935338

Cited by 56 publications

(57 citation statements)

References 35 publications

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“…Patients with partial PM infarction did not differ from patients with MI other than a lack of PM involvement regarding ischemic mitral regurgitation. Compared to results published by Tanimoto et al [17] reporting a prevalence of 40 %, PM infarction was observed less frequently in the present study with a prevalence of 23 %. These results are more in line with a frequency of 19 -32 % as published in autopsy studies [18].…”

Section: Discussioncontrasting

confidence: 93%

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Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Bretschneider

Heinrich

Seeger

et al. 2017

Fortschr Röntgenstr

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This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.the development of mitral regurgitation in patients with chronic myocardial infarction (MI). The aim of the present study was to assess the correlation of PM infarction depicted by MRI with mitral regurgitation and left ventricular function.Methods and Materials 48 patients with chronic MI and recent MRI and echocardiography were retrospectively included. The location and extent of MI depicted by MRI were correlated with left ventricular function assessed by MRI and mitral regurgitation assessed by echocardiography. The presence, location and extent of PM infarction depicted by late gadolinium enhancement (LGE-) MRI were correlated with functional parameters and compared with patients with chronic MI but no PM involvement.Results PM infarction was found in 11 of 48 patients (23 %) using LGE-MRI. 8/11 patients (73 %) with PM infarction and 22/37 patients (59 %) without PM involvement in MI had ischemic mitral regurgitation. There was no significant difference between location, extent of MI and presence of mitral regurgitation between patients with and without PM involvement in myocardial infarction. In 4/4 patients with complete and in 4/7 patients with partial PM infarction, mitral regurgitation was present. The normalized mean left ventricular enddiastolic volume was increased in patients with ischemic mitral regurgitation. ConclusionThe presence of PM infarction does not correlate with ischemic mitral regurgitation. In patients with complete PM infarction and consequent discontinuity of viable tissue in the PM-chorda-mitral valve complex, the probability of developing ischemic mitral regurgitation seems to be increased. However, the severity of mitral regurgitation is not increased compared to patients with partial or no PM infarction.

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Section: Discussioncontrasting

confidence: 93%

“…Published data indicate that PM infarction is usually the result of ischemia of the inferior and inferolateral left ventricular myocardium [17,26]. Due to the vascular anatomy of the PM, the anterior PM is much less frequently affected [11,27].…”

Section: Discussionmentioning

confidence: 99%

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Bretschneider

Heinrich

Seeger

et al. 2017

Fortschr Röntgenstr

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“…[4][5][6] In the vast majority (90%), rupture involves the posteromedial papillary muscle, presumably a consequence of its single source blood supply from either the RCA or LCX coronary artery. 7 In contrast, the anterolateral papillary muscle has a dual source blood supply emanating from both the LAD and LCX coronary arteries, thus providing protection from ischemic rupture. 7 For the patient described herein, an unfortunate constellation of coronary artery occlusions interrupted this dual source blood supply and provided the anatomic substrate for infarction and subsequent rupture.…”

Section: N Discussionmentioning

confidence: 99%

“…7 In contrast, the anterolateral papillary muscle has a dual source blood supply emanating from both the LAD and LCX coronary arteries, thus providing protection from ischemic rupture. 7 For the patient described herein, an unfortunate constellation of coronary artery occlusions interrupted this dual source blood supply and provided the anatomic substrate for infarction and subsequent rupture.…”

Section: N Discussionmentioning

confidence: 99%

Solving a Hemodynamic Enigma

Sharkey¹,

Burke²,

Samara³

et al. 2017

Journal of the Minneapolis Heart Institute Foundation

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This case illustrates the successful implementation of advanced circulatory support in a critically ill patient with acute ST-segment elevation myocardial infarction. The hemodynamic recordings demonstrate the effects of mechanical cardiopulmonary resuscitation, venoarterial extracorporeal membrane oxygenation, and acute severe mitral regurgitation. KEY WORDScardiogenic shock, ST-segment elevation myocardial infarction, ruptured papillary muscle, extracorporeal membrane oxygenation n CASE PRESENTATION A 53-year-old female presented to the emergency department with acute chest pain. The patient experienced the sudden onset of central chest pain radiating into the back with diaphoresis and dyspnea while at work. She called 911 and was transported by emergency medical services to the emergency department. Intermittent chest pain had been present for 2 weeks with sudden worsening on the day of admission. Risk factor profile included 1-pack/day cigarette smoking for 37 years, hypertension, and untreated hyperlipidemia (low-density lipoprotein: 192 mg/dL). Family history was negative for premature coronary events. Past medical history was notable for hypothyroidism and asymptomatic prolonged QT interval. The patient was not receiving antiplatelet agents.Emergency Department Course 9:23 AM. Initial evaluation revealed a diaphoretic acutely ill female with the following vitals: blood pressure, 63/28 mm Hg; heart rate, 86 beats/min; respiratory rate, 14/min; oxygen saturation, 96%; weight, 179 lbs. Figure 1) demonstrated lateral ST-segment elevation. The patient deteriorated rapidly with occurrence of clinical cardiogenic shock and pulseless electrical activity. 9:43 AM. An electrocardiogram (ECG;9:59 AM. The patient was intubated and cardiopulmonary resuscitation (CPR) was initiated with an automatic chest compression system. Epinephrine, dopamine, heparin, aspirin, and ticagrelor were administered. A bedside ultrasound was technically difficult and reported as unremarkable. The initial troponin I was 11.69 ng/mL (99th percentile, 0.033 ng/mL).10:13 AM. The level 1 ST-elevation myocardial infarction (STEMI) system 1,2 was activated and the patient was transported emergently to the cardiac catheterization laboratory.10:25-10:44 AM. Upon arrival in the catheterization laboratory, the patient was intubated and placed on an automatic chest compression system at 100 compressions/min, right femoral artery and vein sheaths were inserted. Initial blood pressure was 85/35 mm Hg, heart rate was 39 beats/min (Figure 2a). Epinephrine, norepinephrine, dopamine, sodium bicarbonate, and heparin were administered.10:44-10:55 AM. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated via the left femoral vein and right femoral artery. Circulation

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“…[4,5] In a recent study by Tanimoto et al, [5] the prevalence and clinical significance of papillary muscle infarction was detected via gadolinium-enhanced magnetic resonance imaging in patients with MI. In this study composed of 47 patients with papillary muscle infarction, the posterior papillary muscle was involved in (77%) while the anterior papillary muscle was involved in only (23%).…”

Section: Discussionmentioning

confidence: 99%

Double papillary muscle infarction related to right coronary artery occlusion: a case report

Güllü¹

2013

Turk Gogus Kalp Dama

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Akut miyokard enfarktüsü sırasında arka papiller kas ön papiller kasa göre daha fazla etkilenir. Ancak her iki papiller kasın enfarktüsü ise oldukça nadirdir. Bu yazıda, sağ koroner arter tıkanıklığına bağlı olabilen iki taraflı papiller kas enfarktüsünün gözlendiği 62 yaşında bir erkek olgu sunuldu. Başarılı bir koroner arter baypas greftleme ve mitral kapak replasmanı sonrasında, hasta sorunsuz bir şekilde taburcu edildi.Anah tar söz cük ler: Akut miyokard enfarktüsü; papiller kas enfarktı; sağ koroner arter tıkanıklığı.Posterior papillary muscle is involved more frequently than the anterior papillary muscle during acute myocardial infarction. However, infarction of both papillary muscles is very rare. In this article, we report a 62-year-old male case with bilateral papillary muscle infarction which was likely related to occlusion of the right coronary artery. Following a successful coronary artery bypass grafting and mitral valve replacement, the patient was discharged without any complication.

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Prevalence and Clinical Significance of Papillary Muscle Infarction Detected by Late Gadolinium-Enhanced Magnetic Resonance Imaging in Patients With ST-Segment Elevation Myocardial Infarction

Cited by 56 publications

References 35 publications

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

Solving a Hemodynamic Enigma

Double papillary muscle infarction related to right coronary artery occlusion: a case report

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