Anterolateral Papillary Muscle Rupture Research Articles

Echocardiographic diagnosis of rupture of mitral valve papillary muscle

ObjectiveTo explore the value of echocardiography in diagnosing papillary muscle rupture (PMR) of the mitral valve, and summarize the characteristic echocardiographic features of different types. MethodsEchocardiograms of 13 PMR patients confirmed by surgery in Wuhan Union Hospital between January 2009 and December 2022 were retrospectively analyzed and their preoperative transthoracic echocardiography (TTE) was compared with surgical findings. ResultsA total of 9020 patients underwent mitral valve repair or replacement surgery during the study period including 13 (0.14%) for PMR. Of the 13 PMRs, 8 cases were partial PMR(P-PMR), 5 cases were complete PMR(C-PMR); 3 cases were anterolateral PMR, and 10 were posteromedial PMR. The diagnostic accuracy, sensitivity, and specificity of the preoperative TTE were 99.9%, 53.8% and 99.9% respectively. Echocardiographic features of 10 patients (5-C-PMR and 5 P-PMR) with detailed TTE and intraoperative transesophageal echocardiography (TEE) data included: both anterior and posterior leaflets prolapse (C-PMR 60% vs P-PMR 60%); flail leaflet (C-PMR100% vs P-PMR 40%); All C-PMRs and P-PMRs have severe, eccentric and lateral regurgitation; flail attachment (chordae tendinae and ruptured PM) at the tip of prolapsed leaflet (C-PMR100% vs P-PMR 60%); high-echo masses resembled “champagne glasses” in 100% of the C-PMR; high-echo masses resembled “lotus-seedpod” in 60% and “dumbbell-shaped” torn PM in remaining 40% of the P-PMR. ConclusionsDifferent PMR subtypes have different echocardiographic characteristics. Combining TTE and TEE can accurately identify the typical features of PMR such as ipsilateral hemipetal leaflet prolapse, high-echoic mass at the tip of the leaflet, massive eccentricity and lateral regurgitation.

Anterolateral Papillary Muscle Rupture Predicted by Post-Infarction Inflammatory Markers.

BACKGROUND The incidence of papillary muscle rupture (PMR), a mechanical complication of acute myocardial infarction, has decreased in the reperfusion era; however, its fatality rate remains high. Timely recognition and prompt initiation of treatment for PMR are important to avoid prolonged cardiogenic shock; however, the symptoms of PMR are nonspecific, and early diagnosis is often difficult. CASE REPORT A 72-year-old woman with nausea for 2 days presented with ST-segment elevation myocardial infarction with obstruction of the obtuse marginal branch and 75% stenosis of the first diagonal branch. Percutaneous coronary intervention was performed to revascularize the obtuse marginal lesion, which was over thrombolysis in myocardial infarction grade 2 flow. After percutaneous coronary intervention, the patient developed fever, an elevated C-reactive protein level, and an increased neutrophil-to-lymphocyte ratio (NLR). The patient showed no signs of infection but elevated inflammatory marker levels, with C-reactive protein rising to 39.32 mg/dL and NLR to 15. On postoperative day 4, the patient's clinical condition rapidly deteriorated, resulting in circulatory failure. Transthoracic echocardiography showed anterolateral PMR, and urgent surgical mitral valve replacement was performed. On day 32, the patient was discharged from the hospital, and at the 1-year follow-up, she remained in good health. CONCLUSIONS When there are multiple lesions, including the obtuse marginal and diagonal branches, anterolateral PMR should be suspected as the cause of cardiogenic shock. Performing point-of-care echocardiography and closely monitoring C-reactive protein levels and NLR can be helpful to detect PMR early.

Traumatic rupture of anterolateral papillary muscle in a patient with congenital deficiency of left hemi-pericardium: case report

Abstract Congenital absence or deficiency of the pericardium or hemi-pericardium is uncommon. When it happens, the protection given to the heart is greatly reduced, and blunt or penetrating trauma to the chest is transmitted directly to the heart. Valvular injuries from these traumas are however rare with a case of tricuspid valve rupture reported. Traumatic papillary muscle rupture in all patients group is also rare. Co-existing rupture of papillary muscle in patients with congenital absence of the pericardium is extremely rare. We report the rare case of a patient with deficient left hemi-pericardium who had a traumatic rupture of the anterolateral papillary muscle from a road traffic accident.

Apparently Spontaneous Partial Rupture of Anterolateral Papillary Muscle Requiring Urgent Surgery

Papillary muscle rupture is a rare complication of myocardial infarction. Here we describe a case of an apparently spontaneous rupture of papillary muscle, not associated with coronary obstruction. The patient was a 73-year-old man admitted to our hospital for diabetic ketoacidosis complicated by acute pulmonary edema and cardiogenic shock. Transthoracic and transesophageal echocardiography showed partial rupture of papillary muscle leading to severe mitral regurgitation. Urgent cardiac surgery with mitral valve replacement was performed.

Anterolateral papillary muscle rupture: a surgical strike, saved by false chordae.

Anterolateral papillary muscle rupture: a surgical strike, saved by false chordae.

ANTEROLATERAL PAPILLARY MUSCLE RUPTURE AS A RESULT OF SINGLE-VESSEL CORONARY ARTERY DISEASE WITHOUT MYOCARDIAL INFARCTION

The rupture of a papillary muscle is usually associated with the previous occurrence of myocardial infarction, but it may have another etiology. The authors of this article have found no reports about anterolateral papillary muscle rupture caused by a single-vessel coronary artery disease without myocardial infarction. In this paper, an extremely rare case of anterolateral papillary muscle rupture caused by chronic ischemia due to single-vessel coronary artery disease is presented. Since the patient of this case had remained hemodynamically stable and responded well to medical treatment, the mitral valve was successfully repaired 6 weeks after the onset of symptoms.

Surgical treatment of mechanical complications following acute myocardial infarction. A Case Series.

Background: Acute myocardial infarction can result in ischemic, mechanical, arrhythmic, embolic or inflammatory complications. Despite high operative mortality, the lack of an effective and immediate medical alternative makes the surgery repair the mainstay of current management for these patients. Novel surgical approaches are presented to manage these complications.
 Main body: Mechanical complications presented at the Department of Cardiac Surgery-Tirana University Medical Centre consisted in nine cases during the period January 2008-June 2018: two anterolateral papillary muscle rupture cases (22%), one posteromedial papillary muscle rupture case (11%), two ventricular septal rupture cases (22%), one free ventricle wall rupture case (11%), three chordae tendineae rupture cases (33%), four out of nine patients (44,5%) underwent concomitant CABG intervention. Intra operator mortality is estimated 11% (one out of nine cases). The Department of Cardiac Surgery-Tirana University Medical Centre is limited only in open surgery techniques for repair the post myocardial infarction mechanical complications. To our personal view key reasons for these results are conditioned from lack of medical devices, trained stuff, reliable short and long outcome data from alternative procedures in order to incorporate thus in our daily practice. Further studies should be undertaken not only to create a precise image of the situation, but also to evaluate the results of the possible changes. 
 Key words: Acute myocardial infarction, mechanical complications, papillary muscle rupture, ventricular septal rupture, free ventricle wall rupture, CABG intervention.

505 Car accident, an unusual cause of acute severe mitral regurgitation due to anterolateral papillary muscle rupture

Abstract A 52-year-old man was admitted to the emergency department of the University Hospital after being involved in a car crash. At first he was alert with stable vital parameters. There was bilateral rales on lung auscultation, without further prominent aberrant findings at the initial clinical examination. Shortly after, he became agitated with respiratory distress, resulting into respiratory insufficiency. Computed tomography (CT) scan of the thorax showed multiple rib fractures, a translated sternal fracture and pulmonary contusion. After intubation and stabilization he was transferred to the Intensive Care Unit (ICU), where his respiratory and cardiovascular parameters progressively worsened, leading to cardiogenic shock. An urgent chest X-ray revealed a tension pneumothorax with mediastinal shift to the right, for which a chest tube was inserted in the left hemithorax. No or little improvement was seen after this intervention. Therefore, an emergency transthoracic echocardiography (TTE) was performed. Subcostal view showed a severe mitral regurgitation with a mass in the left atrium. Because of a limited transthoracic window, we proceeded to a transoesophageal echocardiogram (TEE). A completely ruptured anterolateral papillary muscle of the mitral valve was seen, protruding in the left atrium and resulting in severe mitral regurgitation (Figure). Other echocardiographic findings were a hyperdynamic systolic function of the left ventricle, a hypo-contractile right ventricle with a mild-to-moderate quantity of pericardial effusion. Taking into account the increased cardiovascular risk profile of the patient, a coronary angiography was performed and showed normal coronary anatomy. Consequently, urgent surgical intervention was performed. Perioperative assessment confirmed the earlier described echocardiographic findings. Due to severe laceration of the left ventricular wall at the level of the attachment site of the anterolateral papillary muscle, reconstructive surgery was not possible. The anterolateral papillary muscle head with the attached mitral valve leaflet was fully excised with repair of the concealed myocardial rupture site. A mechanical mitral valve prosthesis and an intra-aortic balloon pump for hemodynamic support were placed. After four days the balloon pump was removed and the tenth day after admission the patient was extubated. Conclusion Acute severe mitral regurgitation due to papillary muscle rupture is a rare but potential fatal complication of a blunt trauma. TOE is essential in early diagnosis. Abstract 505 Figure 1

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

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.

Anterolateral Papillary Muscle Rupture Caused by Myocardial Infarction: A case report

<p>Abstract </p><p>Background: </p><p>The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle since the anterolateral muscle has dual blood supplies, while the posteromedial papillary muscle has a single blood supply. <strong></strong></p><p>Case presentation: </p><p>We present a case report of a 62 year old Sudanese male presenting with acute inferior ST segment elevation myocardial infarction (STEMI), underwent primary PCI (percutaneous intervention) to the right coronary artery. One hour after the PCI, he had sudden heart failure Kilip class IV, with significant shortness of breath, required intubation. Diagnosed to have mitral regurgitation from the complete rupture of the anterolateral papillary muscle due to coronary artery disease. The Transthoracic images were not enough to show the mitral valve apparatus and the transeophageal echocardiography as a gold standard showed clearly the rupture of the antero-lateral papillary muscle. The patient underwent a mitral valve replacement and concomitant coronary artery bypass grafting of the right coronary artery and left circumflex artery. <strong></strong></p><p>Conclusion: </p><p>Acute mitral regurgitation can be precipitated by acute myocardial infarction due to rupture of the anterolateral papillary muscle. <strong></strong></p>

Anterolateral Papillary Muscle Rupture Caused by Brucella Endocarditis

Introduction: Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products (e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran. Case Presentation: A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a ruptured anterolateral papillary muscle from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet. Conclusions: This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography (TEE) revealed large mobile vegetation on the anterior papillary muscle with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and rupture of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves.

Anterolateral Papillary Muscle Rupture Caused by Brucella Endocarditis

Introduction:: Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products (e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran. Case Presentation:: A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a ruptured anterolateral papillary muscle from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet. Conclusions:: This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography (TEE) revealed large mobile vegetation on the anterior papillary muscle with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and rupture of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves.

Anterolateral papillary muscle rupture caused by myocardial infarction: A case report

The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle, as the anterolateral muscle has dual blood supply, whereas the posteromedial papillary muscle has a single blood supply. We present a a 49 years old male patient who has presented with chest pain and dyspnoea. A transesophageal echocardiogram was performed which showed that the mitral valve was normal in thickness with a flail anterior leaflet not coapting with the posterior leaflet due to the coronary artery disease. The patient underwent a mitral valve replacement and left anterior coronary artery and obtuse marginal bypass grafting.

Papillary Muscles Rupture as Delayed Sequelae of Trauma

Background : Spontaneous rupture of papillary muscle from sepsis is extremely rare. Most cases of papillary muscle ruptures are due to myocardial infarction or trauma. We describe a case of spontaneous acute papillary muscle rupture in absence of history of ischemic cardiomyopathy or blunt chest trauma. Case Report: A 42 year-old man was transferred to intensive care unit with signs and symptoms of cardiogenic shock. Past history revealed that he had met with a road traffic accident 19 months ago with fracture mid shaft of left femur. He was treated for the same and failed to have regular follow up visits. Physical examination revealed osteomyelitis at the fractured site with sinus formation and pyrexia. His general condition declined thereafter and expired due to cardiac failure few hours later. At autopsy there was rupture of antero-lateral papillary muscle of mitral valve. Microscopic section of the ruptured papillary muscle revealed formation of focal abscess with neutrophil infiltration. Conclusion: Papillary muscle ruptures are associated with significantly increased morbidity and mortality. Therefore early diagnosis is very important in providing appropriate treatment. This case emphasized the fact that delay in diagnosis and institution of appropriate antimicrobial therapy for sepsis may result in life threatening complications. Although this occurrence is uncommon, papillary muscle necrosis and subsequent rupture must be considered as cause of delayed deaths in cases of road traffic accidents with septicemia.

An Unusual Case of Cardiogenic Shock: Common Cause From Uncommon Etiology

Mechanical complications of an acute coronary syndrome can lead to hemodynamic instability out of proportion to the degree of left ventricular dysfunction. We present the case of a patient with cardiogenic shock secondary to severe mitral regurgitation in the setting of an acutely occluded obtuse marginal artery. Echocardiography and pathologic findings revealed an uncommon cause of anterolateral papillary muscle rupture. Using the unique features of this case, we present a clinical self-assessment exercise highlighting the challenges involved in the management of this type of patient.

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

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.

Severe Mitral Regurgitation due to Traumatic Anterolateral Papillary Muscle Rupture: A Case Report

A 29-year-old man was admitted for abrupt dyspnea and hemoptysis. An echocardiogram revealed severe mitral regurgitation due to papillary muscle rupture for which an emergency mitral valve replacement operation was performed 4 days after admission. Herein, we report our experience with this case along with a review of the literature.

Isolated right coronary lesion and anterolateral papillary muscle rupture - case report and review of the literature

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.

Mitral Anterolateral Papillary Muscle Rupture in an Asymptomatic Patient with Mitral Stenosis after Percutaneous Mitral Balloon Valvuloplasty

Percutaneous mitral valvuloplasty is the procedure of choice for the treatment of patients with mitral stenosis and suitable valve anatomy. Papillary muscle rupture is the most worrisome complication of this procedure. Three‐dimensional transesophageal echocardiography (3D TTE) is additive to conventional two‐dimensional imaging in these patients in terms of three‐dimensional perspective and anatomically correct examination. We herein present a case of anterolateral papillary rupture in an asymptomatic patient after percutaneous mitral balloon valvuloplasty demonstrated by 3D TEE.

Isolated Papillary Muscle Rupture Complicating Acute Pancreatitis

Papillary muscle rupture in the absence of coronary stenoses is a rare event. An isolated infarction of the papillary muscle is involved in most cases, but the pathogenesis is still debated. We describe an anterolateral papillary muscle rupture complicating acute pancreatitis in a patient without significant coronary stenoses and with evidence of coronary spasm. This suggests that an increased susceptibility to coronary spasm and thrombosis, triggered by an acute systemic inflammatory response, may represent a mechanism of selective papillary muscle infarction.