Partial Papillary Muscle Rupture Research Articles

Late mitral leaflet tear after transcatheter edge-to-edge repair for acute ischemic mitral regurgitation: a case report

Abstract Background Acute mitral regurgitation due to papillary muscle rupture is a severe complication of acute myocardial infarction. Transcatheter edge-to-edge repair is emerging as an effective alternative to surgical treatment, with encouraging outcomes. Leaflet adverse events are rare and are associated with relapse of significant mitral regurgitation. Case summary A 54-year-old man arrived at our hospital with a late presentation of ST-elevation myocardial infarction. During primary percutaneous coronary intervention of the circumflex coronary artery, a partial papillary muscle rupture occurred with acute severe mitral regurgitation and cardiogenic shock. Due to the severe hemodynamic instability, the patient underwent an emergent transcatheter edge-to-edge repair with MitraClip device during Impella support with mitral regurgitation resolution and hemodynamic stabilization. At 2-month follow-up an interclip leaflet tear occurred with relapse of severe mitral regurgitation, requiring a mitral valve replacement surgery. Discussion Acute mitral regurgitation due to papillary muscle rupture is a serious complication of acute myocardial infarction. Management is based on hemodynamic stabilization and surgery. The transcatheter edge-to-edge repair is emerging as a therapeutic alternative in high-risk cases. Leaflet adverse events rarely occur during the transcatheter edge-to-edge repair procedure or before patient discharge. Our case is the first to report a late leaflet adverse event, occurring two months after the procedure and, interestingly, after an acute myocardial infarction conditioning an ischemic mitral regurgitation. This event may be the result of the progressive adverse remodeling of left ventricular inferolateral akinetic wall, with consequent increase of tethering forces on the posterior leaflet, tensioned in the opposite direction by the clip.

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.

Severe mitral regurgitation following partial rupture of papillary muscle: The role of intraoperative transesophageal echocardiography

Papillary muscle rupture (PMR) is an uncommon mechanical complication of myocardial infarction which warrants timely diagnosis and urgent surgical intervention to maximize survival chances. Echocardiography is an essential diagnostic tool, whereas transesophageal echocardiography can provide accurate diagnosis and guide decision-making. We hereby present the case of a patient with partial PMR that presented for cardiac surgery in our institution, with the respective intraoperative echocardiographic findings.

Left ventricular assist device, HeartMate II — our experience

Cardiologia CROATICA Mechanical support of circulation with a left ventricular assist device (LVAD) is a rapidly evolving field. In this article we present three patient cases that involve implantation of a LVAD called HeartMate II (HM II), and describe different strategies for treating patients with the terminal stage of heart failure (HF) and the indications for placement of a LVAD. Patient 1 — N. S. 66 y, M. The patient has a history of arterial hypertension (AH), diabetes mellitus type II (DM II), and a myocardial infarction in September 2011. Clinical suspicion for HF was confirmed by echocardiography, which showed global left ventricular hypertrophy, an ejection fraction of 20%, mitral regurgitation, and normal right ventricular dimensions. Coronary arteriography showed triple vessel disease and scintigraphy showed scar tissue without viable myocardium. In October 2011, HM II was indicated as destination therapy. The only incident worth nothing was an infection at the exit site of the cannula that occurred one year later and was treated without complications. The patient continues to perform laborious tasks on his farm and refuses to quit. Patient 2 — ©. J. 65 y, F. The patient has a history of AH, DM II, and terminal HF with LVAD implantation in April 2010. In October 2011, the heart transplantation was required due to a resilient infection at the HM II stoma that led to sepsis. In June 2012, a syncopal event subsequent to asystole indicated the need for implantation of a permanent pacemaker. The patient currently feels well and tolerates physical activity. Patient 3 — V. H. †63 y, F. The patient has a history of DM II, STEMI treated with primary PCI, triple vessel CAD, double CABG, femoral and iliac artery disease, renal and hepatic dysfunction, and vascular changes in the brain. Echocardiography showed left ventricular dilation, contractibility of only the base of the left ventricle, and an EF of ~15%. In December 2011, HM II was indicated as destination therapy. Due to anti-heparin antibodies implantation was postponed until May 2012, when it was performed alongside CABG (RCA-SVG). Three months later, the patient sustained NSTEMI. In February 2013, the patient was hospitalized for left ventricular failure due to partial papillary muscle rupture and resultant mitral insufficiency. Blood cultures at the time were negative. In April 2013, the patient died of multiorgan failure. Autopsy reports found a destroyed mitral valve without evidence of endocarditis.

Partial Papillary Muscle Rupture: A Cause of Acute Mitral Regurgitation

A 56-year-old woman presented to the cardiology clinic with a 7-day history of dyspnea and chest pressure. An echocardiogram showed a flail posterior mitral valve leaflet, and subsequent left heart catheterization showed complete occlusion of the first obtuse marginal coronary artery. Further investigation demonstrated the culprit lesion to be ischemic partial rupture of the posteromedial papillary muscle. Timely recognition of this condition allowed for an optimal clinical outcome. In this Cardiology Grand Rounds, the authors further describe the above presentation of ischemic partial papillary muscle rupture and provide a brief review of the pathophysiology, diagnosis and treatment of this condition.

Acute ST-Segment Elevation Myocardial Infarction Complicated by Partial Papillary Muscle Rupture

Acute Mitral Regurgitation (MR) after an acute Myocardial Infarction (MI) can be a catastrophic complication of acute MI and requires early recognition and emergent surgical intervention. The classic presentation is that of acute pulmonary edema and cardiogenic shock with recent history of MI. However, we present a case in which a patient presented with acute myocardial infarction and within a few hours, after percutaneous intervention, developed pulmonary edema and shock; reminding readers that this mechanical complication of MI can present at any time and may present with varying severity of symptoms. A high clinical suspicion should be maintained in order to recognize this serious complication and to expedite definitive surgical and life-saving treatment.

Transaortic repair of blunt traumatic cardiac wall and papillary muscle rupture

Transaortic repair of blunt traumatic cardiac wall and papillary muscle rupture

Echocardiographic detection of complete and partial papillary muscle rupture during acute myocardial infarction

L'echocardiographie permet de reconnaitre une lesion du pilier mitral avant sa rupture complete et ainsi l'intervention peut etre plus precoce