[Complete Anterior Papillary Muscle Rupture with Angiographically Normal Coronary Arteries;Report of a Case]
Masaaki Sugawara1, Hiroyuki Hirahara, Maya Watanabe
1Department of Cardiovascular Surgery, Japanese Red Cross Nagaoka Hospital, Nagaoka, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|May 13, 2020
Summary
A rare case of spontaneous papillary muscle rupture (PMR) occurred in a woman without significant coronary artery disease. Repeated localized infarction likely caused the complete rupture, leading to severe mitral regurgitation and cardiogenic shock.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Background:
- Papillary muscle rupture (PMR) is a rare but life-threatening complication often associated with myocardial infarction.
- Prompt diagnosis and surgical intervention are crucial for managing PMR and severe mitral regurgitation.
Observation:
- A 69-year-old woman presented with acute orthopnea and cardiogenic shock.
- Echocardiography revealed severe mitral regurgitation secondary to anterior PMR.
- Coronary angiography showed no obstructive coronary artery disease.
Findings:
- Complete rupture of the anterolateral papillary muscle was confirmed intraoperatively.
- Pathologic examination revealed both old fibrosis and acute ischemic lesions within the ruptured papillary muscle.
- Mitral valve replacement was successfully performed with leaflet preservation.
Implications:
- This case suggests that localized, repeated subendocardial infarction can lead to spontaneous PMR, even without significant obstructive coronary artery disease.
- The findings highlight the importance of considering non-obstructive coronary artery disease etiologies for PMR.
- Successful surgical management underscores the viability of valve replacement in such critical cases.
