Real Time Three‐Dimensional Transesophageal Echocardiography in Partial Posteromedial Papillary Muscle Rupture

Abstract

A 60-year-old hypertensive male with non-ST segment elevation myocardial infarction had a hyperdynamic LV with mild posterior leaflet mitral valve prolapse without significant regurgitation on transthoracic echocardiogram. Two-dimensional (2D) TEE showed severe mitral regurgitation with prolapse of P2 and P3 scallops. Posteromedial papillary muscle rupture was suspected. Three-dimensional (3D) TEE demonstrated severely prolapsing P2 and P3 valve scallops with a clear view of the partially ruptured posteromedial papillary muscle. Patient underwent emergency coronary bypass and mitral valve replacement. Surgical pathology of papillary muscle confirmed coagulative necrosis. 3D TEE was superior in identifying the partial posteromedial papillary muscle rupture.

Clinical and echocardiographic presentation of postmyocardial infarction papillary muscle rupture

“…Transesophageal echocardiography remains the modality of choice for evaluation of the mitral valve with a diagnostic yield between 95% and 100% . Recent reports have suggested that 3D echocardiography might help in the diagnosis and surgical management of PMR . Unfortunately, this modality of imaging was not used in any of the patients included in this study.…”

Clinical presentation and echocardiographic diagnosis of postinfarction papillary muscle rupture: A review of 22 cases

“…TEE provides superior imaging of the mitral apparatus and the papillary structures compared to TTE. Multiple reviews are available describing the different TEE views in which accurate evaluation of the papillary muscles can be obtained . New real time 3D imaging of the mitral apparatus can also increase the sensitivity of the TEE in diagnosing PMR .…”

Role of Three‐Dimensional Echocardiography in Structural Complications after Acute Myocardial Infarction

“…Three‐dimensional echocardiography overcomes the limitations of the difficult process of mentally reconstructing the complex cardiac structures from multiple 2DE tomographic views . Particularly, the unique capability of 3DE to visualize cardiac structures from any desired perspective is key to allow en face views of myocardial ruptures complicating AMI …”

“…3 Particularly, the unique capability of 3DE to visualize cardiac structures from any desired perspective is key to allow en face views of myocardial ruptures complicating AMI. [4][5][6][7][8] Acute VSD usually occurs within the first week and presents high mortality rate if prompt diagnosis and treatment are not initiated. In our first 2 cases, 3D transthoracic echocardiography (TTE) allowed a comprehensive noninvasive assessment of the location, shape, and size of the VSD, which could be visualized en face from both left and right ventricular perspectives.…”