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Mitral valve repair in papillary muscle rupture

Umar Imran Hamid1, Rezan Aksoy1, Peyman Sardari Nia1

  • 1Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.

Annals of Cardiothoracic Surgery
|June 23, 2022
PubMed

Insights

Papillary muscle rupture (PMR) after heart attack causes severe mitral regurgitation (MR). Treatment options include surgery or transcatheter devices, but long-term outcomes require further study.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Papillary muscle rupture (PMR) is a life-threatening mechanical complication of myocardial infarction (MI).
  • PMR leads to severe mitral regurgitation (MR), often causing cardiogenic shock and pulmonary edema.
  • This condition necessitates urgent medical and surgical interventions.

Purpose of the Study:

  • To review current management strategies for papillary muscle rupture (PMR) following myocardial infarction (MI).
  • To compare surgical interventions (mitral valve repair vs. replacement) and emerging transcatheter device therapies.
  • To emphasize the importance of a multidisciplinary mitral heart team approach.

Main Methods:

  • Review of existing literature on PMR and mitral regurgitation (MR) management.
  • Analysis of outcomes associated with surgical mitral valve repair and replacement.
  • Evaluation of the role of transcatheter devices as a bridge to recovery or treatment.

Main Results:

  • Surgical mitral valve repair may offer better left ventricular function but carries risks of failure and longer cross-clamp times.
  • Mitral valve replacement is an alternative, with concomitant coronary revascularization potentially improving outcomes.
  • Transcatheter devices present a novel approach, but long-term efficacy data are pending.

Conclusions:

  • Management of PMR requires careful consideration of multiple treatment modalities.
  • A dedicated mitral heart team is crucial for optimal patient management.
  • Further long-term data are needed to compare the efficacy of surgical versus transcatheter interventions.
Keywords:
Papillary muscle rupture (PMR)mitral clipmitral valve repairmyocardial infarction (MI)neochordae

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