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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Isolated papillary muscle rupture with nonobstructive coronary artery disease, minimal myocardial infarction, and

Eleni S Nakou1, Konstantinos C Theodoropoulos1, Hizbullah Shaikh2

  • 1Department of Cardiology, King's College Hospital, London, UK.

Echocardiography (Mount Kisco, N.Y.)
|October 4, 2020
PubMed

Insights

Isolated papillary muscle infarction causing rupture is rare, even with clear coronary arteries. This condition can mimic other mitral valve masses on echocardiograms, emphasizing the need for broader diagnostic considerations.

Area of Science:

  • Cardiology
  • Cardiac Pathology
  • Echocardiography

Background:

  • Papillary muscle (PM) rupture typically complicates myocardial infarctions, but isolated PM infarction is exceptionally rare.
  • The precise pathophysiological mechanisms underlying isolated PM infarction and subsequent rupture remain incompletely understood.

Observation:

  • We describe a unique case of papillary muscle rupture resulting from isolated PM infarction in a patient presenting with unobstructed coronary arteries.
  • Transthoracic echocardiography revealed no regional wall motion abnormalities (RWMAs), leading to a potential misdiagnosis of vegetation or other cardiac masses.

Findings:

  • The study identified isolated papillary muscle infarction as a cause of PM rupture, even in the absence of coronary artery disease.
  • The absence of RWMAs on echocardiography can complicate the diagnosis of ischemic PM rupture.

Implications:

  • This case underscores the importance of considering ischemic papillary muscle rupture in the differential diagnosis of severe mitral regurgitation with mitral valve masses, irrespective of RWMAs.
  • Clinicians should maintain a high index of suspicion for papillary muscle rupture in specific echocardiographic presentations, even with seemingly normal coronary arteries.
Keywords:
cardiogenic shockmitral regurgitationpapillary muscles (PM)transesophageal echocardiography

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