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

• Published in: Annals of Thoracic and Cardiovascular Surgery Vol. 20; no. Supplement; pp. 926 - 928
• Main Authors: Doi, Toshio, Nagura, Saori, Fukahara, Kazuaki, Yoshimura, Naoki
• Format: Journal Article
• Language: English
• Published: Japan The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery 2014
• Subjects: Aged, 80 and over; Cardiopulmonary Bypass; Coronary Angiography; Coronary Artery Bypass; Coronary Occlusion - complications; Coronary Occlusion - diagnosis; Coronary Occlusion - surgery; Female; Heart Rupture, Post-Infarction - diagnosis; Heart Rupture, Post-Infarction - etiology; Heart Rupture, Post-Infarction - physiopathology; Heart Rupture, Post-Infarction - surgery; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Intra-Aortic Balloon Pumping; Intubation, Intratracheal; mechanical complications of acute myocardial infarction; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - etiology; Mitral Valve Insufficiency - surgery; papillary muscle rupture; Papillary Muscles - diagnostic imaging; Papillary Muscles - physiopathology; Papillary Muscles - surgery; Severity of Illness Index; Shock, Cardiogenic - etiology; surgical management; Treatment Outcome; Ultrasonography
• ISSN: 1341-1098; 2186-1005
• DOI: 10.5761/atcs.cr.13-00171

Papillary muscle rupture is a lethal complication of after acute myocardial infarction. We report the successful surgical management of complete anterolateral papillary muscle rupture associated with cardiogenic shock in an 80-year-old woman. The patient was admitted with the sudden onset of chest pain and dyspnea. After hemodynamics deteriorated rapidly, she was intubated and intra-aortic balloon pump was started immediately. Transthoracic echocardiography revealed severe mitral regurgitation due to complete anterolateral papillary muscle rupture associated with lateral myocardial infarction. Coronary angiography demonstrated complete occlusion of the first obtuse marginal artery. She underwent emergency mitral valve replacement and coronary artery bypass grafting. There were no complications of surgery and she was discharged on postoperative day 35. Rapid preoperative assessment and aggressive surgical management are important to improve the prognosis in this setting.