Muscle Rupture Research Articles

Anti-inflammatory effect of berberis vulgaris extract in vivo

Background and Aims: Atherosclerosis is initiated by damage to the endothelium, accumulation of inflammation tissue, foam cell formation, migration and proliferation of vascular smooth muscle cell and rupture of the plaque causing the formation of the thrombus. Once adhere platelet surface was exposed, and these promote further endothelial dysfunction and inflammation. The aim is to examine the anti-inflammatory effect of Berberis vulgaris in atherosclerotic- induced rabbit.

Extracorporeal Membrane Oxygenation (ECMO) Rescue Therapy in Post-cardiotomy Cardiogenic Shock: A Case Report.

Cardiogenic shock is a constant challenge for the intensivist when complicating a myocardial infarction, due to the high rate of associated morbidity and mortality, especially in the setting of mechanical complications such as papillary muscle rupture.We present the case of a 49-year-old woman with cardiogenic shock due to acute myocardial infarction (AMI) complicated by severe mitral valve insufficiency due to papillary muscle rupture. She was treated initially by medical optimization, followed by mitral valve replacement and complete surgical revascularization, requiring rescue mechanical circulatory support by extracorporeal membrane oxygenation (ECMO).ECMO proved to be a rescue therapy in a patient with refractory cardiogenic shock after urgent cardiac surgery.

Prepubic tendon rupture in Santa Inês ewe – case report

Prepubic tendon rupture may lead to the loss of pelvic floorsupport. A four-year-old Santa Inês ewe had been reported suffering fromapathy, progressive weight loss throughout ten days, and prolongedpregnancy. Physical exams showed an excessive pendulous abdomen, amild ventral edema between the udder and the umbilical scar (xiphoidregion). Also, the udder was cranially displaced and with hematomas.Other symptoms noticed were walking reluctance, pelvic asymmetry,tachycardia, and tachypnea. The urinalysis findings indicated the presenceof ketone bodies. The ultrasound examination confirmed the presence offetuses with normal development, and a potential rupture of theabdominal muscles was excluded. Eight days following its hospitalization,labor induction was carried out using dexamethasone (20mg, IM, singleapplication). She went into labor three days after the initial dose ofcorticosteroid. The ewe had difficulty expelling the lambs, making theirtraction necessary. Although the animal has recovered from its injuries,the clinical picture shows prepubic tendon rupture, and in order to preventfuture complications, the ewe is not going to breed anymore. The report ofthis case works as an alert to the possibility of the occurrence of thisaffection in ewes and demonstrates the need of parturition assistance inanimals with this condition, which can be diagnosed through clinicalevaluation and ultrasound examination.

Abstract 14887: Look Beyond the Coronaries: A Rare Cause of Acute Papillary Muscle Rupture

A 63-year-old male with numerous cardiac risk factors presented with two hours of rapidly progressing chest pain and shortness of breath. Exam was notable for respiratory distress requiring non-invasive mechanical ventilation and a holosystolic apical murmur radiating to the axilla. He had an elevated troponin and an electrocardiogram with anteroseptal ST depressions. He was diagnosed with a non-ST segment elevation acute coronary syndrome and taken for cardiac catheterization. Surprisingly, no occlusive epicardial disease was discovered. Left ventriculogram revealed engorgement of the left atrium and pulmonary arteries suggestive of severe mitral regurgitation. The mechanism of mitral regurgitation was unclear until transesophageal echocardiography showed a ruptured posteromedial papillary muscle with flail mitral valve, a picture classically caused by myocardial infarction. Cardiac MRI demonstrated preserved LV function with minor inferior apical hypokinesis, nonspecific endocardial late gadolinium enhancement in the inferior segments, and a small LV thrombus. An embolic myocardial infarction targeting a small territory involving posteromedial papillary muscle was thought most probable. The patient then underwent an uneventful mitral valve replacement and recovery. However, he returned two months later with severe biventricular dysfunction and cardiogenic shock with peripheral eosinophilia. Myocardial biopsy confirmed the diagnosis of eosinophilic myocarditis. An exhaustive workup for the etiology of his eosinophilia proved unrevealing; he was consequently diagnosed with the idiopathic subtype. The case highlights a rare but important clinical entity that has a varied phenotype. Our patient presented atypically with an acute papillary muscle rupture that mimicked an acute myocardial infarction, ultimately delaying diagnosis. As evidenced by our case, clinical suspicion of myocarditis should be high in all patients presenting with typical anginal symptoms with mechanical or circulatory compromise in the absence of acute coronary occlusion.

Abstract 17020: Nationwide Analysis to Determine Mechanical Circulatory Support Device Use in Mechanical Complications of Acute Myocardial Infarction

Introduction: Without timely reperfusion therapy, acute myocardial infarction (AMI) can lead to mechanical complications (MC) such as papillary muscle rupture (PMR), ventricular septal rupture (VSR), free wall rupture (FWR). Mechanical circulatory support (MCS) devices such as intra-aortic balloon pump (IABP), Impella and extracorporeal membrane oxygenation (ECMO) are used in cardiogenic shock associated with AMI-MC. Hypothesis: As per the SHOCK-II trial use of MCS in MI complicated cardiogenic shock showed no difference in mortality. We sought to determine the rates of AMI-MC, MCS device placements and outcomes associated with them. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 codes with a primary diagnosis of AMI. We also used diagnosis and procedure codes for MC and MCS devices. We excluded patients with NSTEMI. Results: From 2010 to 2014, we identified 3158 hospitalizations related to AMI-MC with a mean age of 64±13.4 years. Majority were men 69% with 75% Caucasian with an in-hospital mortality rate of 37%. Use of MCS was most common in males (67%), Caucasians (77%), and with an age group of 50-70 years (54%). Of these patients, PMR was noted in 13%, VSR in 31% and FWR in 56%. Rates of MCS devices were 38% (IABP 35%, Impella 3% and ECMO 4%). Overall use of MCS for FWR, VSR, PMR were 15%, 61%, 80%. Percentage of MC requiring IABP, Impella, ECMO were as follows; FWR (15%, 0.6%, 0.3%), VSR (58%, 7%, 6%), PMR (70%, 5%, 12%). Patients that received cardiac transplant was 0.2%. In-hospital mortality among patients who received MCS to those who did not receive MCS were 59% vs 24%; p<0.001, among patients who received IABP to those who did not receive any MCS were 54% vs 24%; p<0.001 and among patients who received Impella to no MCS were 86% vs 24%; p<0.001. Conclusions: Based on the results, FWR was the most common MC. MCS were most commonly used in PMR followed by VSR, with IABP being the most common type. Patients on MCS had increased in-hospital mortality compared to those without MCS. Large randomized trials are needed to determine the effectiveness of these devices in predicting outcomes associated with AMI-MC

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.

Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support

Abstract Background Acute mitral regurgitation (MR) is an emergency, often requiring urgent surgery. Severe acute MR presenting with hemodynamic collapse is usually caused by papillary muscle rupture or dysfunction after acute myocardial infarction (AMI) or chordal rupture, resulting in flail mitral leaflet(s). Preoperative stabilization is complex due to concomitant hemodynamic collapse and hypoxic respiratory failure. Finding the right balance between both preload and inotropic support is challenging. When patients are too sick for immediate surgical intervention, mechanical circulatory support can be considered because of its ability to both unload and reduce of cardiac work while increasing coronary perfusion and cardiac output. Nevertheless, even after initial stabilization, surgical risk remains high in critically ill acute severe MR patients and transcatheter treatments such as MitraClip are increasingly being explored. Methods Between August 2017 and September 2019, patients presenting with acute severe mitral regurgitation and considered too ill for immediate surgical intervention (EURO-II score >11.2% plus pulmonary oedema necessitating mechanical ventilation and/or hemodynamic instability), were selected for an Impella-assisted LV unloading technique as bridge to MitraClip-procedure. Five patients were selected for the combined left Impella/MitraClip-procedure in two tertiary cardiac ICUs. Results The mean age was 72 years. The cause of MR was ischemic in 20% and all patients presented in cardiogenic shock state, necessitating mechanical ventilation. The overall cardiac operative risk assessment (Euro-II) score predicted a 35% chance of in-hospital mortality. Cardiac output was severely impaired (mean LVOT VTI 8.2 cm). All patients were on inotropic support and supported by an Impella-CP pVAD (mean flow 2.5 Liter per minute; mean 6.3 days of support). In all cases, we managed to reduce the LVEDP below 15 mmHg using the combination of medical therapy (afterload reduction, inotropes), mechanical ventilation and pVAD-therapy. The MR was significantly reduced by a MitraClip-procedure in each Impella supported patient. The overall survival at discharge was 80%. One patient with late referral and multiple organ failure at presentation deceased due to refractory cardiogenic shock. Overall, severe MR was reduced to grade 1+ and all four patients survived 6 months after discharge with only one readmission for decompensated heart failure. Conclusions A combined strategy of Impella and MitraClip appears to be a novel, feasible alternative for patients presenting with acute, severe MR unable to proceed to a corrective surgical procedure at presentation due to severe left ventricular forward flow failure. In these cases, the early initiation of pVAD-support may reduce the risk of development of irreversible end- organ damage and dysfunction. Exploration in a larger, randomised population is warranted to investigate this strategy further. Funding Acknowledgement Type of funding source: None

Severe tricuspid regurgitation due to papillary muscle rupture: a rare complication of anterior myocardial infarction and ventricular septal perforation.

Severe tricuspid regurgitation due to papillary muscle rupture: a rare complication of anterior myocardial infarction and ventricular septal perforation.

A clinical study to evaluate the efficacy of Murivenna application on Episiotomy Wound

A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor is called episiotomy (Perineotomy). It is in fact an inflicted second-degree perineal injury. It is the most common obstetric operation performed. This is done to enlarge the vaginal introitus to facilitate easy and safe delivery of the fetus and to minimize overstretching and rupture of the perineal muscles and fascia thus to reduce the stress and strain on the fetal head. This wound of episiotomy is associated with a delicate area of the female with immense pain and discomfort and seeks appropriate medical care and attention. If ignored, it may lead to puerperal wound infections and delayed healing that can interfere mother-infant interaction, lactation and prolonged hospital stay. Episiotomy wound care should be start immediately after suturing the wound in order to reduce pain and inflammation. The surgical wound of episiotomy can be considered as Sadyo Vrana. Different treatment modalities have been told in Ayurveda for Vrana Chikitsa. Drugs having Shodhana and Ropana qualities are essential for healing. In this research study total 30 patients were registered and treated in two groups, group A with application of Jatyadi Taila on episiotomy wound after Ushna Jala Parisheka as a standard control group and Group B with application of Murivenna after Ushna Jala Parisheka as a trial group. Encouraging results were observed in Murivenna. Study emerges that Murivenna possess better pain relieving and tenderness diminishing properties.

Rupture of Papillary Muscle and Chordae Tendinae Complicating STEMI: A Call for Action.

Papillary muscle rupture (PMR) or chordae tendinae rupture (CTR) is a rare but lethal complication after ST elevation myocardial infarction (STEMI). Due to the rarity of this condition, there are limited studies defining its epidemiology and outcomes. This is a retrospective study from Nationwide Inpatient Sample database from 2002 to 2014 of patients with STEMI and PMR/CTR. Outcomes of interest were incidence of in-hospital mortality, cardiogenic shock (CS), utilization of mechanical circulatory support (MCS) devices and mitral valve procedures (MVPs) among patients with and without rupture. We also performed simulation using the cardiovascular model to better understand the hemodynamics of severe mitral regurgitation and effects of different medications and device therapy. We identified 1,888 patients with STEMI complicated with PMR/CTR. Most of the patients were >65 years of age (65.3%), male (63.6%), and white (82.3%). They had significantly higher incidence of CS, cardiac arrest, and utilization of MCS devices. In-hospital mortality was higher in patients with rupture (41% vs. 7.40%, p < 0.001) which remained unchanged over the study period. Hospitalization cost and length of stay was also higher in them. MVP and revascularization led to better survival rates (27.9% vs. 60.6%, adjusted OR: 0.14; 95% CI: 0.10-0.19; p < 0.001). Despite significant advancement in the revascularization strategy, PMR/CTR after STEMI continues to portend poor prognosis with high inpatient mortality. Cardiogenic shock is a common presentation and is associated with significantly inpatient mortality. Future studies are needed determine the best strategies to improve outcomes in patients with STEMI with PMR/CTR and CS.

Perioperative Extracorporeal Membrane Oxygenation for Refractory Cardiopulmonary Failure Complicating Papillary Muscle Rupture

The prognosis of papillary muscle rupture (PMR) leading to acute mitral regurgitation, pulmonary oedema, and cardiogenic shock remains dismal, with survival dependent on prompt recognition and surgical intervention. The use of extracorporeal membrane oxygenation (ECMO) for circulatory and/or respiratory support in critically ill patients failing conventional treatment has significantly increased in the past few years, mainly owing to technology improvements that have rendered the provision of this technique simpler and safer. In this report, four cases of refractory cardiopulmonary collapse complicating ischaemic and traumatic PMR successfully managed perioperatively with ECMO are presented. In this context, a review of the potential role of perioperative ECMO support for cardiogenic shock secondary to cardiac mechanical complications is also provided.

An experimental study of hamstring muscle rupture under different loading modes

Lesions of the Musculotendinous Unit (MTU) are a common pathology in musculoskeletal disorders and sports injuries which are a leading cause of functional impairment, long-term pain, and/or physica...

Signo “manchas de tigre” en síndrome coronario agudo

The incidence of mitral regurgitation in acute myocardial syndromes is variable. Echocardiographic evaluation is fundamental in making a proper diagnosis of mechanical complications and to offer timely treatment. We present a case of a 64-year-old male who was admitted to the ER in acute pulmonary edema. The electrocardiogram showed negative ST-segment deviation from V4-V6, positive ST-segment deviation in aVR. Multivessel disease with severe mitral regurgitation was seen in catheterization. A transthoracic echocardiogram revealed important mitral regurgitation showing the tiger stripes sign, seen in the presence of intracardial oscillating structures, in this case, suspected papillary muscle rupture. Echocardiographic evaluation is necessary in every case of myocardial infarction who present with new-onset mitral regurgitation. Treatment is complex and must be determined with an interdisciplinary group.

Successful Repair of Neonatal Tricuspid Regurgitation Due to Papillary Muscle Rupture: A Rare Case

Background: Neonatal rupture of the chordae of the tricuspid valve with severe regurgitation is scarce and devastating.Case report: Here, we report the case of a full-term male neonate presented with cyanosis caused by severe tricuspid regurgitation due to anterior leaflet papillary muscle rupture. Following initial stabilization by the infusion of prostaglandins E1, successful early repair was achieved.Conclusion: Early diagnosis of the tricuspid valve papillary muscle rupture is critical, and early surgical repair have a good result during early post-operative period.

Longus capitis and rectus capitis ventralis minor rupture in a horse following general anaesthesia for a laryngeal tie-forward procedure

The authors present a case of a racehorse with acute respiratory distress, bilateral epistaxis and laryngeal swelling following a laryngeal tie-forward procedure. An emergency tracheostomy was performed following brief endoscopic...

Predictors of hospital mortality after surgery for ischemic mitral regurgitation: the Toronto General Hospital experience.

The benefit of mitral valve repair (MVr) over replacement in patients with severe ischemic mitral regurgitation (IMR) is still controversial. We report our early postoperative outcomes of repair versus replacement. Data were collected for patients undergoing first-time mitral valve surgery for severe IMR between 1990 and 2009 (n = 393). Patients who underwent combined procedures for papillary muscle rupture, post-infarction ventricular septal defect, endocarditis, or any previous cardiac surgery were excluded. Preoperative demographics, operative variables, and hospital outcomes were analyzed, and multivariable regression analysis was employed to identify independent predictors of hospital mortality. Valve repair was performed in 42% (n = 164) of patients and replacement in 58% (n = 229). Patients who underwent replacement were older and had a higher prevalence of unstable angina, New York Heart Association Class IV symptoms, preoperative cardiogenic shock, preoperative myocardial infarction, peripheral vascular disease, renal failure, and urgent or emergency surgery (all p < .05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% vs. 5%; p = .01). Valve repair was associated with a lower prevalence of postoperative low cardiac output syndrome. Multivariable analysis revealed that age, urgency of operation, and preoperative left ventricular (LV) function were independent predictors of hospital mortality. Importantly, MVr versus replacement was not an independent predictor of hospital mortality. Our data did not suggest an early survival benefit to MVr over replacement for IMR. However, age, LV dysfunction, and the need for urgent surgery were independently associated with hospital mortality.

Mid-Term Follow-Up of Neonatal Neochordal Reconstruction of Tricuspid Valve for Perinatal Chordal Rupture Causing Severe Tricuspid Valve Regurgitation

Papillary muscle rupture in the perinatal period is a rare event that leads to severe mitral or tricuspid insufficiency due to a flail leaflet. Neonatal tricuspid chordal reconstruction for this condition is rarely reported. Early recognition and treatment have the potential to be lifesaving. We present our surgical experience with five such patients, along with their midterm follow-up. Between August 2010 and November 2012, five neonates (aged 1-30 days) underwent surgery for severe atrioventricular valve regurgitation. All neonates had severe tricuspid regurgitation due to ruptured chordae. In addition, two had moderate mitral regurgitation; one due to ruptured chordae of the posterior mitral leaflet and the other due to prolapse of the anterior mitral leaflet. All underwent emergent surgery where the ruptured chordae to the anterior tricuspid leaflet were replaced with neochordae made with expanded polytetrafluoroethylene (ePTFE) suture. The mitral valve was repaired in two patients. All patients survived surgery without the need for postoperative mechanical circulatory assist. Predischarge echocardiograms showed good coaptation of tricuspid and mitral leaflets with minimal regurgitation in all. At follow-up between 75 months to 102 months, four patients had excellent outcomes with less than mild tricuspid regurgitation. One child with flail tricuspid and mitral leaflets developed progressive tricuspid and mitral regurgitation requiring surgical re-repair at 20 months following the initial surgery. Repair of chordal rupture of the tricuspid valve in neonates using ePTFE neo-chordae can provide acute salvage and gratifying midterm results in the management of this potentially fatal condition.

Long-Term Outcomes of the Knee and Hip Arthroplasties in Patients with Alkaptonuria

Alkaptonuria is a rare autosomal recessive metabolic disorder. It is characterized by the accumulation of homogentisic acid in the body due to a lack of enzymes that degrade it. Over time, it results in joint degeneration and eventually leads to ochronosis. Ochronosis refers to bluish-black discoloration of connective and other tissues within the body. In this study, we present 5 distinct cases diagnosed with alkaptonuria. They have undergone 8 total joint replacement surgeries (4 hips and 4 knees) within 8 years (2010-2018). All patients had an excellent outcome over several years. The follow-up period ranged from 2 to 10 years. Although none of the presented cases had intraoperative or postoperative adverse sequelae, we must take care when dealing with patients with ochronotic arthropathy. They carry a higher risk of complications than other patients with osteoarthritis disease. These complications include fractures due to fragile bone quality, muscle or tendon rupture, joint instability, and anesthesia-related complications. Total joint arthroplasty is a valid and safe option in the management of hip and knee ochronotic arthropathy.

The use of extracorporeal membrane oxygenation in the setting of postinfarction mechanical complications: outcome analysis of the Extracorporeal Life Support Organization Registry.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently considered and used for patients with post-acute myocardial infarction mechanical complications (post-AMI MC); however, information in this respect is scarce. The purpose of this study was to evaluate the in-hospital outcomes of patients with post-AMI MC submitted to VA-ECMO, and enrolled in the Extracorporeal Life Support Organizations (ELSO)'s data Registry. This was a retrospective review of the ELSO Registry to identify adult (>18 years old) patients with post-AMI MC who underwent VA-ECMO support between 2007 and 2018. The primary end point of this study was in-hospital survival. ECMO complications were also evaluated. The patient cohort available for this study included 158 patients. The median age was 62.4 years (range 20-80). The most common post-AMI MC was ventricular septal rupture (n = 102; 64.5%), followed by papillary muscle rupture (n = 42; 26.6%) and ventricular free-wall rupture (n = 14; 8.9%). Approximately a quarter of patients (n = 41; 25.9%) had cardiac arrest before VA-ECMO institution. The median duration of VA-ECMO was 5.9 days (range 1 h-40.3 days). ECMO complications occurred in 119 patients (75.3%). Overall, survival to hospital discharge for the entire patient cohort was 37.3%. Patients who had ventricular septal rupture as primary diagnosis had higher in-hospital mortality (n = 66; 64.7%). In patients with post-AMI MC, VA-ECMO provides haemodynamic stabilizations and carries a potential to reverse otherwise lethal course. ECMO complications, however, remain an important limitation. Further investigations are required to better evaluate the efficacy and safety of ECMO in this context.

Awareness level of general population regarding acute chest pain in Aseer region, Southern of Saudi Arabia

Background: Myocardial infarction is caused by sudden closure of a coronary artery due to plaque rupture. Symptoms include chest pain, which travels from left arm to neck, dyspnea, sweating, nausea, vomiting, arrhythmia, anxiety, fatigue and weakness. Complications of acute myocardial infarction include papillary muscle rupture and mitral regurgitation, ventricular septal rupture, free-wall rupture, and right ventricular infarction. Adequate awareness of acute chest diseases improves medical consultation for suspected cases by general population.Methods: A descriptive cross-sectional approach was used targeting all population in Aseer region. The study was conducted during the period from December 2019 to March 2020. Data were collected using structured questionnaire included person’s socio-demographic data, Participants’ family history regarding heart attack, participants’ awareness regarding acute chest pain.Results: A total sample of 1287 respondents was included in the study. About 54% of the respondents aged 30 years or more and 65.3% were females. Only 9.2% of the participants correctly defined heart attack. Regarding symptoms, 59.9% of the participants reported left arm pain, 57.1% reported difficulty breathing and 29% told about burning sensation in middle of the chest. Totally, nearly one quarter of the participants had good awareness level regarding heart attack.Conclusions: In conclusion, the population awareness regarding heart attack and stroke is poor. Also, population with high risk were more knowledgeable. More effort should be paid to improve the public knowledge of stroke, more effective community-based education programs should be organized constantly with screening for population at high risk.