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Acute posteromedial papillary muscle rupture secondary to aortic valve endocarditis: a case report

Akira Marumoto1, Takayuki Shijo1, Masako Okada2

  • 1Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003, Japan.

European Heart Journal. Case Reports
|March 17, 2022
PubMed
Abstract

Insights

Infective endocarditis can cause papillary muscle rupture, a rare complication. This case highlights posteromedial papillary muscle rupture in primary aortic valve endocarditis, emphasizing early diagnosis and multidisciplinary care for this severe condition.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • Infective endocarditis is a serious infection affecting heart valves.
  • Papillary muscle rupture is a known, albeit uncommon, complication of infective endocarditis.
  • Rupture of the posteromedial papillary muscle in primary aortic valve endocarditis without aortic root abscess is particularly rare.

Observation:

  • An 81-year-old male presented with fever and vision loss.
  • Echocardiography showed aortic valve regurgitation due to a perforated cusp; blood cultures identified Group G Streptococci.
  • During antibiotic treatment, the patient developed acute mitral regurgitation due to posteromedial papillary muscle rupture.

Findings:

  • The papillary muscle rupture was likely caused by a metastatic infectious focus from the aortic valve via a regurgitant jet.
  • Histological findings supported the metastatic infection theory.
  • Prompt surgical intervention and antibiotics led to successful recovery.

Implications:

  • This case underscores the importance of recognizing rare complications of infective endocarditis.
  • A multidisciplinary approach involving cardiology, infectious diseases, and cardiac surgery is crucial for managing such complex cases.
  • Early diagnosis and prompt surgical intervention are vital for improving outcomes in patients with infective endocarditis-related papillary muscle rupture.
Keywords:
Aortic valve regurgitationCase reportInfective endocarditisMetastatic foci of infectionMultidisciplinary approachPapillary muscle rupture

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