Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction

Vincelj, Josip; Biočić, Stanko; Udovičić, Mario; Sičaja, Mario; Jurinjak, Sandra Jakšić

doi:10.17392/793-15

Cited by 2 publications

(3 citation statements)

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“…This improvement is confirmed by a study, showing that normalization of EF and reverse remodeling of the dimensions of the left ventricle is possible with immediate surgical correction of degenerative MR [5]. The transesophageal echocardiography (TOE) is also a great method for diagnostics of PMR, especially with the addition of color Doppler imaging, which helps in evaluating the severity of the MR [6], [7], [8]. It is a valuable diagnostic tool with 65-85% sensitivity in visualizing structural abnormalities [10].…”

Section: Discussionmentioning

confidence: 85%

Papillary Muscle Rupture as a Complication of Barlow’s Disease

et al. 2022

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INTRODUCTION: Mitral regurgitation (MR) is the second most common valvulopathy worldwide, which can be divided into primary and secondary. According to Carpentier’s classification, the primary MR is further divided into three types. Type II, which includes Barlow’s disease, is described as excessive mobility of the mitral valve (MV) leaflets. Morbus Barlow is a common form of degenerative disease, with an incidence of 2–3% of the general population. Echocardiography plays an important role in its diagnosis. It is a usually benign condition, with only a few severe complications. CASE REPORT: A 75-year-old male with a history of MR, for more than 10 years. On admission, the patient presented with severe fatigue and dyspnea with signs of heart failure and pleural effusion. On auscultation, a systolic murmur was noted, on all the precordium. The ECG revealed sinus rhythm with HR of 71/min and intermittent ventricular extrasystoles. An immediate transthoracic echocardiography (TTE) was performed showing myxomatous degeneration of both MV leaflets and a prolapse of the posterior leaflet. A severe MR was detected with a presumption of papillary muscle rupture (PMR). It also revealed enlarged left atrium and ventricle (LVEDd - 67 mm and LA - 46 mm), with preserved systolic function (EF~54%) and tricuspid regurgitation accompanied by pulmonary hypertension. The laboratory analyses were within normal ranges. The patient was transferred to a cardiovascular surgery clinic, where an immediate MV repair was performed. CONCLUSION: Barlow’s disease is a common echocardiography finding. Although a benign condition, it can rarely present with serious complications such as PMR, ventricular arrhythmias, and even sudden cardiac death. Echocardiography is the first imaging used for the detection of Barlow’s disease and other MV diseases. Early recognition and confirmation with TTE or transesophageal echocardiography, plays also an appropriate treatment, play a key role in patient survival and overall prognosis.

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Section: Discussionmentioning

confidence: 85%

Papillary Muscle Rupture as a Complication of Barlow’s Disease

et al. 2022

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“…However, subsequent TEE confirmed the presence of severe mitral valve regurgitation with papillary rupture, and he underwent definitive treatment with surgical MVR that completely resolved his symptoms. While TTE is the standard of care for initial cardiac workup, it is not as sensitive as TEE and cannot rule out AMR in the setting of papillary muscle rupture [ 12 ]. TTE can identify a papillary muscle rupture with a diagnostic sensitivity of 65-85%; TEE is a valuable adjunct as it provides more detailed anatomic information and improves the diagnostic yield to 95–100%, especially if the damage is subtle [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…While TTE is the standard of care for initial cardiac workup, it is not as sensitive as TEE and cannot rule out AMR in the setting of papillary muscle rupture [ 12 ]. TTE can identify a papillary muscle rupture with a diagnostic sensitivity of 65-85%; TEE is a valuable adjunct as it provides more detailed anatomic information and improves the diagnostic yield to 95–100%, especially if the damage is subtle [ 12 , 13 ]. Therefore, hemoptysis with right-sided infiltration on CXR and/or CT chest indicative of pulmonary edema or alveolar hemorrhage, even without hemodynamic stability, should raise clinical concern for AMR and prompt cardiac evaluation to prevent the delay of necessary intervention in these critical patients.…”

Section: Discussionmentioning

confidence: 99%

Hemoptysis and Unilateral Pulmonary Infiltrates due to Severe Acute Mitral Regurgitation from Papillary Muscle Rupture

Wieckowska,

Diloreto,

Hood

et al. 2024

Case Reports in Pulmonology

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Acute mitral regurgitation typically presents with dyspnea, chest pain, and hemodynamic instability. It is an uncommon cause of hemoptysis. We present a case of a patient presenting with dyspnea and hemoptysis without hemodynamic instability along with right-sided infiltrate on chest radiography a few days after an acute inferolateral STEMI who was found to have posterior papillary muscle rupture resulting in acute mitral regurgitation. Our case illustrates that the aforementioned symptoms and signs should raise concern for acute mitral regurgitation and prompt cardiac evaluation in the appropriate clinical setting as they may mimic acute pulmonary processes and delay critical diagnosis and treatment.

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Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction

Abstract: To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle.

Cited by 2 publications

References 1 publication

Papillary Muscle Rupture as a Complication of Barlow’s Disease

Papillary Muscle Rupture as a Complication of Barlow’s Disease

Hemoptysis and Unilateral Pulmonary Infiltrates due to Severe Acute Mitral Regurgitation from Papillary Muscle Rupture

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