Abstract
Ischemic rupture of the anterolateral papillary muscle is uncommon due to its dual blood supply. It usually follows an ischemic event involving branches of the left circumflex or left anterior descending arteries. We present a case of a patient admitted with an acute inferior wall myocardial infarction and an isolated distal right coronary artery occlusion. Acute mitral regurgitation with rupture of the anterolateral papillary muscle was diagnosed on the fifth post-infarction day. The patient underwent mitral valve replacement and coronary artery bypass grafting to the posterior descending artery. We conclude that anterolateral papillary muscle rupture may also result from an isolated right coronary lesion.
Highlights
Myocardial ischemia and infarction may lead to different papillary muscle involvements including prolapse, elongation or rupture
We present a case of acute anterolateral papillary muscle rupture, 5 days post myocardial infarction, in the presence of an isolated distal right coronary artery (RCA) occlusion
We present a case of acute rupture of the anterolateral papillary muscle, secondary to occlusion of the distal RCA
Summary
Myocardial ischemia and infarction may lead to different papillary muscle involvements including prolapse, elongation or rupture. The posteromedial papillary muscle has, in most cases, a single blood supply from the posterior descending branch of a dominant right coronary artery (RCA). Papillary muscle rupture is optimally diagnosed by transesophageal echocardiography with high sensitivity and specificity. Patients with this condition usually undergo urgent surgical intervention with associated high mortality rates. We present a case of acute anterolateral papillary muscle rupture, 5 days post myocardial infarction, in the presence of an isolated distal RCA occlusion. A transthoracic echocardiography revealed ejection fraction of 40% and a ruptured anterolateral papillary muscle with severe mitral regurgitation. Intraoperative findings included a complete rupture of the anterolateral papillary muscle head creating free mitral regurgitation (Figure 4). On the 9th postoperative day the patient developed acute kidney failure (treated with continuous hemofiltration) and on the 12th postoperative day, the patient died, from septic shock
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