Related Experiment Video

Updated: Nov 14, 2025

An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
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A Case Report on Papillary Muscle Rupture Following Mitral Valve Replacement in the Setting of Previously Undiagnosed

Nadim Choudhury1, Ronny Munoz Acuna1, Omar Chaudhary1

  • 1From the Department of Anesthesia, Critical Care and Pain Medicine.

A&A Practice
|March 8, 2021
PubMed

Insights

Papillary muscle rupture (PMR) after mitral valve replacement (MVR) can occur without coronary artery disease (CAD). Cardiac amyloidosis, particularly AL-type, is a key cause, impacting mortality and requiring specific therapy.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pathology

Background:

  • Mitral valve replacement (MVR) is a common cardiac surgery.
  • Preservation of the subvalvular apparatus is a surgical technique.
  • Papillary muscle rupture (PMR) is a rare but serious complication.

Observation:

  • A patient developed anterolateral PMR post-MVR despite no history of coronary artery disease (CAD).
  • Pathology revealed amyloid deposition in the ruptured papillary muscle.
  • Cardiac amyloidosis, especially amyloid light-chain (AL) subtype, can affect heart function.

Findings:

  • Amyloid deposition, not CAD-related ischemia, was the cause of PMR in this case.
  • Cardiac amyloidosis is an underrecognized cause of PMR in MVR patients without CAD.
  • AL-type amyloidosis significantly increases mortality risk.

Implications:

  • Consider cardiac amyloidosis in MVR patients with PMR and no CAD history.
  • Early diagnosis and therapy for cardiac amyloidosis can mitigate mortality.
  • This case highlights the importance of comprehensive pathology in unexplained cardiac complications.

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