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Papillary muscle rupture: an unusual complication of chordal sparing mitral valve replacement

Michael A Long1, M Med

  • 1Department of Cardiothoracic Surgery, Faculty of Health Sciences, Free State University, Bloemfontein, South Africa.

Journal of Cardiac Surgery
|November 16, 2010
PubMed

Insights

A rare complication of papillary muscle head infarction and rupture occurred after mitral and aortic valve replacement in a rheumatic heart disease patient. Prompt surgical resection of the ruptured head led to an uneventful recovery.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Pathology
  • Rheumatic Heart Disease

Background:

  • Chordal sparing mitral valve replacement (CSVMR) and aortic valve replacement (AVR) are complex procedures.
  • Rheumatic heart disease (RHD) can present unique challenges in valve surgery due to chronic inflammation and fibrosis.
  • Preservation of papillary muscle chordae during CSVMR aims to maintain left ventricular geometry and function.

Observation:

  • An adult patient with advanced RHD underwent combined CSVMR and AVR.
  • Postoperatively, the patient developed an infarction of the retained anterolateral papillary muscle head.
  • This resulted in spontaneous rupture of the papillary muscle head 72 hours after surgery.

Findings:

  • The ruptured papillary muscle head was successfully resected through an aortotomy via the aortic valve prosthesis.
  • The patient experienced an uneventful recovery following the intervention.
  • This case highlights a rare but serious complication of CSVMR in the context of RHD.

Implications:

  • Emphasizes the critical need for meticulous surgical technique to avoid excessive tension on preserved chordae during CSVMR, particularly in RHD.
  • Suggests that papillary muscle infarction and rupture, though rare, should be considered in the differential diagnosis of postoperative complications after mitral valve surgery.
  • Underscores the importance of careful postoperative monitoring for potential mechanical complications following complex valve reconstructions.

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