Transesophageal Echocardiographic Assessment of Papillary Muscle Rupture

Moursi, Mohamed; Bhatnagar, S. K.; Vilacosta, Isidre; Román, José Alberto San; Espinal, Miguel; Nanda, Navin C.

doi:10.1161/01.cir.94.5.1003

Cited by 56 publications

(40 citation statements)

References 20 publications

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“…33 Our encouraging finding of life-expectancy restoration is particularly remarkable in view of the spontaneously catastrophic outcome of post-MI MR, 4 particularly that caused by PMR, 3 and underscores the importance of appreciating MR 34 and of considering the diagnosis of PMR in patients with acute hemodynamic compromise in whom this diagnosis may be challenging. 35,36 These findings also emphasize the importance of surgical correction of PMR after MI, even in patients with severe presentation. 4 Operating without delay does not carry excess risk, emphasizing the feasibility of early suppression of this mechanical complication of MI.…”

Section: Long-term Outcomementioning

confidence: 66%

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

et al. 2008

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Background-Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined. Methods and Results-Fifty-four consecutive patients (age, 70Ϯ8 years; 74% male) underwent mitral surgery for post-MI PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; Pϭ0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65Ϯ7%, and survival free of congestive heart failure was 52Ϯ7%. Five-year survival of 30-day operative survivors was 79Ϯ4%, identical (Pϭ0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28Ϯ8% versus 36Ϯ6%; Pϭ0.46). Conclusions-Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI. (Circulation. 2008;118:1528-1534.)

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Section: Long-term Outcomementioning

confidence: 66%

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

et al. 2008

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“…However, more cases may remain undiagnosed and untreated than those previously reported because the disease is sometimes fatal without appropriate treatment. The known etiology includes rheumatic fever [1], bacterial or viral endocarditis and myocarditis [2], myxomatous mitral valve [3], blunt chest trauma [5], Kawasaki disease [6], myocardial infarction [7], and Marfan's syndrome [11]. An interesting finding in this patient is the fibrotic scar formation observed at the chordae tendinae and the posterior papillary muscle.…”

Section: Discussionmentioning

confidence: 98%

A neonate with the rupture of mitral chordae tendinae associated with maternal-derived anti-SSA antibody

et al. 2008

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Acute mitral insufficiency due to the rupture of chordae tendinae from papillary muscles is a rare but sometimes fatal condition in neonates and infants. Here, we report a 21-day-old neonate with sudden onset of mitral insufficiency due to rupture of the chordae tendinae. The baby was successfully rescued by appropriate diagnosis and emergency surgical operation with reconstruction of the ruptured chordae using autologous pericardium-reinforced mattress suture. Intraoperative findings revealed fibrous scar formation at the distal end of the posterior papillary muscle, indicating a remnant of a certain inflammatory reaction. Transplacental passage of maternal anti-SSA antibody could account for the fetal inflammation at the ruptured chordae and the papillary muscle.

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“…However, in some cases, transthoracic echocardiography is not informative and transesophageal echocardiography is required to establish the diagnosis; this is most likely to occur when the ruptured head does not prolapse into the left atrium, as was observed in our patient, a feature reported in up to 35% of cases. 9 Emergency surgical intervention remains the treatment of choice for papillary muscle rupture. Surgery involves significant operative mortality (18%), but there are recent trends for lower operative risk, particularly with associated CABG (8.7%).…”

Section: Discussionmentioning

confidence: 99%

Ischemic rupture of the anterolateral papillary muscle

Vieira

Gaspar

Pereira

et al. 2013

Revista Portuguesa de Cardiologia

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We describe the case of a 59-year-old man who presented with chest pain and ST-segment elevation in the inferior leads, R > S in V1 and ST depression in the anterior leads due to proximal occlusion of the first obtuse marginal. Primary coronary angioplasty and stenting of this artery were performed. Twelve hours later the patient became hemodynamically unstable and severe mitral regurgitation due to rupture of one of the heads of the anterolateral papillary muscle was diagnosed. Emergency surgery was performed (papillary muscle head reimplantation, mitral annuloplasty with a rigid ring, tricuspid annuloplasty and coronary artery bypass grafting). On surgical inspection, it was observed that the detached muscle head had become trapped in the left ventricle by a secondary cord attached to the other head.This case is unusual in presenting two uncommon features of ischemic papillary muscle: rupture of the anterolateral muscle in myocardial infarction involving the inferoposterior walls, and the fact that the ruptured muscle head did not prolapse because it had become trapped in the left ventricle by secondary cord attachment. © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. PALAVRAS-CHAVEMúsculo papilar; Rutura; Reimplantação cirúrgica; Ecocardiograma Rutura isquémica do músculo papilar ântero-lateralResumo Apresentamos um caso de um homem, de 59 anos de idade, admitido no Serviço de Urgência por dor torácica e elevação ST nas derivações inferiores, r > s em V1 e depressão ST nas derivações precordiais, devido a oclusão da primeira obtusa marginal. Foi realizada angioplastia primária dessa lesão com implantação de stent revestido. Doze horas depois, o doente desenvolve instabilidade hemodinâmica, tendo sido diagnosticada uma insuficiência mitral grave por rutura de uma das cabeças do músculo papilar ântero-lateral. O doente foi submetido a cirurgia emergente (reimplantação do músculo papilar ântero-lateral, anuloplastia mitral com anel rígido, anuloplastia tricúspide e revascularização miocárdica). A inspeção cirúrgica revelou que a cabeça muscular rompida se mantinha presa ao ventrículo esquerdo por uma corda secundária que a ligava à outra cabeça do músculo papilar ântero-lateral.

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Transesophageal Echocardiographic Assessment of Papillary Muscle Rupture

Cited by 56 publications

References 20 publications

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

A neonate with the rupture of mitral chordae tendinae associated with maternal-derived anti-SSA antibody

Ischemic rupture of the anterolateral papillary muscle

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