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A Case of Anterolateral Papillary Muscle Rupture Caused by Isolated First Diagonal Branch Occlusion

Hiroshi Kodama1, Shinya Takahashi1, Keijiro Katayama1

  • 1Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Japan.

The Heart Surgery Forum
|December 23, 2017
PubMed

Insights

A rare case of acute myocardial infarction (AMI) led to cardiogenic shock from anterolateral papillary muscle rupture (PMR). This study highlights the importance of considering PMR in AMI patients presenting with severe mitral regurgitation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Acute myocardial infarction (AMI) can lead to life-threatening complications.
  • Papillary muscle rupture (PMR) is a rare but severe mechanical complication following AMI.
  • Cardiogenic shock necessitates prompt diagnosis and intervention.

Observation:

  • A 74-year-old male presented with cardiogenic shock secondary to AMI of the first diagonal branch.
  • Ultrasonography revealed anterolateral papillary muscle rupture (PMR).
  • The PMR resulted in anterior mitral leaflet prolapse and severe mitral valve regurgitation.

Findings:

  • Successful mitral valve replacement was performed.
  • Anterolateral PMR causing anterior mitral leaflet prolapse is an uncommon presentation of AMI.
  • Obstruction of the first diagonal branch was implicated in the PMR.

Implications:

  • This case underscores the need to consider PMR in the differential diagnosis of cardiogenic shock post-AMI.
  • Early recognition and surgical intervention are crucial for managing this rare complication.
  • Understanding the specific coronary artery involvement (first diagonal branch) may offer insights into PMR etiology.

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