Left ventricular papillary muscle rupture due to acute myocardial infarction after transcatheter aortic valve
Tatsuya Horibe1, Kosuke Nakata1, Takafumi Hirota1
1Department of Cardiovascular Surgery, Kumamoto University Hospital, Kumamoto, Japan.
Introduction:
Mitral regurgitation is a potential complication of transcatheter aortic valve replacement. Here, we report a case of severe acute mitral regurgitation caused by papillary muscle rupture occurring 16 days after transcatheter aortic valve replacement.
Presentation Of Case:
An 82-year-old woman with severe AS was referred to our hospital. Transfemoral transcatheter aortic valve replacement was scheduled. Preoperative computed tomography revealed that the height of the left coronary artery was 8.7 cm, and a self-expandable valve was selected. The procedure was performed successfully without coronary obstruction. A complete atrioventricular block was observed on postoperative day 5, and a pacemaker was implanted. On postoperative day 13, the patient suddenly developed dyspnoea. Coronary angiography revealed stenosis of the left main coronary artery, and percutaneous coronary intervention was successfully performed. However, on postoperative day 16, she again developed sudden dyspnoea. Transoesophageal echocardiography revealed severe mitral regurgitation caused by rupture of the left ventricular papillary muscle. An emergency mitral valve replacement was performed. Her postoperative course was uneventful.
Discussion:
Left ventricular papillary muscle rupture due to acute myocardial infarction after transcatheter aortic valve replacement is rare. In case of anatomical risk of coronary artery occlusion after transcatheter aortic valve replacement with a self-expandable valve, careful observation for delayed coronary obstruction should be continuously performed, even when the valve is placed in a low position.
Conclusion:
Severe MR due to papillary muscle rupture can be a complication of TAVR. In such cases, emergency mitral valve replacement should be performed.
Insights
Severe mitral regurgitation from papillary muscle rupture is a rare complication following transcatheter aortic valve replacement (TAVR). Prompt emergency mitral valve replacement is crucial for patient recovery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for severe aortic stenosis.
- Mitral regurgitation (MR) is a known, albeit infrequent, complication post-TAVR.
- Papillary muscle rupture is a severe cause of acute MR.
Observation:
- An 82-year-old woman underwent TAVR with a self-expandable valve.
- Post-TAVR, she developed complete atrioventricular block and later acute dyspnea.
- Coronary angiography revealed left main coronary artery stenosis, treated with PCI.
- On postoperative day 16, sudden dyspnea recurred, diagnosed as severe MR due to papillary muscle rupture.
Findings:
- The patient experienced severe acute mitral regurgitation.
- The cause was identified as left ventricular papillary muscle rupture.
- This occurred 16 days after the initial TAVR procedure.
Implications:
- Papillary muscle rupture leading to severe MR is a rare but critical complication of TAVR.
- Continuous monitoring for delayed coronary obstruction is vital, especially with self-expandable valves.
- Emergency mitral valve replacement is indicated for severe MR due to papillary muscle rupture post-TAVR.
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