Complete rupture of the posterior papillary muscle caused by late reperfusion for acute myocardial infarction.

The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyōbu Geka Gakkai Zasshi
Keiji KamoharaJunichi Murayama

Abstract

We describe a patient with acute mitral regurgitation due to complete rupture of the papillary muscle immediately after successful late reperfusion for inferior myocardial infarction. An 81-year-old woman was admitted complaining of mild chest discomfort. Although the electrocardiograms, biochemical test results, and her clinical history showed that several days had passed since the onset of acute myocardial infarction, a late coronary stenting was performed. Immediately after successful stenting, she suddenly developed acute pulmonary edema, leading to cardiogenic shock. In addition to high pulmonary capillary wedge pressure (mean 35 mmHg), color Doppler imaging revealed massive mitral regurgitation caused by complete rupture of the posterior papillary muscle. Emergent mitral valve replacement with a prosthetic valve was performed, saving the patient. Hence, late reperfusion should be considered carefully when treating a patient with a high risk, such as an elderly patient or a patient with single-vessel disease or initial transmural myocardial infarction.

References

Jun 29, 1999·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·R PapaleoJ L Houghton
Apr 19, 2002·JAMA : the Journal of the American Medical Association·Thomas AversanoUNKNOWN Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT)
Oct 2, 2002·Journal of Thrombosis and Thrombolysis·Kinji Ishikawa
Aug 7, 2004·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Philippe ChevalierPaul Touboul
Nov 16, 2004·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jérome JouanChristophe Acar

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Citations

Apr 1, 1966·American Heart Journal·A R Gomez, H A Jackson

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