A reappraisal of papillary muscle dysfunction: Correlative clinical and angiographic study

Abstract

Fourteen patients with mitral insufficiency due to papillary muscle dysfunction and fifty control subjects with coronary atherosclerosis but no mitral insufficiency were evaluated clinically and studied by right and left heart catheterization, selective coronary arteriography and left ventricular cineangiography. The murmur of this condition was found to vary in timing from early to late systole or to be holosystolic; the site, radiation and intensity of the murmur were inconstant. These features bore no relation to the degree of angiographically visualized mitral insufficiency, but there was precise correlation between timing of onset of regurgitation by ventriculography and timing of the murmur within systole. Seven of the control subjects who had murmurs clinically indistinguishable from the patient group did not have angiographically demonstrable mitral regurgitation. No characteristic electrocardiographic pattern was found nor could specific papillary muscle group involvement be distinguished angiographically. All patients had three vessel coronary artery disease, but with an increased incidence of severe right coronary artery lesions. Abnormal left ventricular systolic contraction was found in all but one of the patient group. The hemodynamic abnormalities such as markedly reduced cardiac output may be as much due to the left ventricular asynergy as to the mitral incompetence. This factor deserves full consideration if corrective surgery of the valvular lesion is contemplated.