Rupture of the Anterolateral Papillary Muscle Caused by a High Lateral Branch Occlusion

Kayo Sugiyama,Masaki Kano,Hitoshi Ogino,Satoshi Takahashi,Nobusato Koizumi

doi:10.4236/ojts.2018.81002

Abstract

Although necrosis of the left ventricular papillary muscles during acute myocardial infarction is common, rupture of the anterolateral papillary muscle due to occlusion of high lateral branch is rare. We present a rare case of anterolateral papillary muscle rupture caused by occlusion of a high lateral branch of the left coronary artery. Although the patient was in cardiogenic shock on admission, she was successfully treated by emergency mitral valve replacement after percutaneous catheter intervention and intra-aortic balloon pumping support. This case implies that the anterolateral papillary muscle can have a single blood supply and that it can be ruptured by an occlusion of a high lateral branch. Prompt diagnosis, immediate mechanical stabilization and aggressive surgical treatment are essential to save this group of patients.

Highlights

Necrosis of the papillary muscle (PM) potentially occurs due to acute myocardial infarction (AMI), rupture of the anterolateral PM is rare because of its dual blood supply
We present a rare case of anterolateral papillary muscle rupture caused by occlusion of a high lateral branch of the left coronary artery
This case implies that the anterolateral papillary muscle can have a single blood supply and that it can be ruptured by an occlusion of a high lateral branch

Summary

Introduction

Necrosis of the papillary muscle (PM) potentially occurs due to acute myocardial infarction (AMI), rupture of the anterolateral PM is rare because of its dual blood supply. We present a rare case of rupture of the anterolateral PM caused by total occlusion of a high lateral branch of the left coronary artery causing acute-onset severe mitral regurgitation (MR). A 78-year-old woman was admitted for sudden onset of chest pain who was 150 cm in height and weighed 36 kg On admission, she presented with cardiogenic shock. With the diagnosis of AMI, emergency coronary angiography was performed 30 minutes after the admission, which revealed total occlusion of a high lateral branch of left coronary artery and mild stenosis of the left anterior descending artery (Figure 1(b)). Chest radiography after the PCI showed severe bilateral pulmonary edema without cardiomegaly (Figure 2(a)), and following echocardiography revealed massive MR with prolapse of the (a). To improve the hemodynamic state, intra-aortic balloon pumping was started in addition to revascularization

Surgery and Postoperative Course

Findings

Discussion