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A Hybrid Intervention for Post-infarction Papillary Muscle Rupture with Severe Mitral Regurgitation: A Case Report

Kosuke Nakamae1, Takashi Oshitomi1, Hideyuki Uesugi1

  • 1Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

Journal of Chest Surgery
|March 16, 2022
PubMed

Insights

Papillary muscle rupture after heart attack causes severe mitral regurgitation and shock. A hybrid surgery combining angioplasty and valve replacement improved an elderly patient's outcome, offering a less invasive option.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Papillary muscle rupture is a rare but serious complication of acute myocardial infarction (AMI).
  • Severe acute mitral regurgitation resulting from this rupture leads to pulmonary congestion and cardiogenic shock, carrying a high mortality rate.
  • Traditional surgical interventions, including revascularization, have high mortality, especially in elderly patients.

Observation:

  • A case report details an 85-year-old female patient presenting with cardiogenic shock due to severe acute mitral regurgitation following papillary muscle rupture post-AMI.
  • The patient underwent a novel hybrid intervention.
  • This procedure combined percutaneous coronary intervention (PCI) with minimally invasive mitral valve replacement (MVR) via a minithoracotomy approach.

Findings:

  • The hybrid intervention successfully treated the severe acute mitral regurgitation and cardiogenic shock.
  • The patient was discharged in a favorable clinical condition.
  • This approach potentially minimizes surgical invasiveness in elderly patients.

Implications:

  • This hybrid strategy offers a potentially less invasive treatment option for acute myocardial infarction complications like papillary muscle rupture and severe mitral regurgitation.
  • It may reduce surgical risks and prevent post-intervention disuse syndrome in elderly patients.
  • Successful implementation requires significant technical skill and interdisciplinary collaboration, demanding careful case selection.
Keywords:
Acute mitral regurgitationCase reportHybrid interventionMinimally invasive cardiac surgeryMitral valve replacementPapillary muscle rupture

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