Related Experiment Video
Updated: May 3, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
TEER for Severe Mitral Regurgitation With Cardiogenic Shock Caused by Bilateral Papillary Muscle Rupture
Zheng Hu1, Hong-Ning Song2, Qing Zhou2
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Background:
Mitral regurgitation (MR) caused by bilateral papillary muscle (PM) rupture is a rare yet critical complication of acute myocardial ischemia.
Case Summary:
A 75-year-old man developed spiral dissection of the left circumflex artery during percutaneous coronary intervention that led to posterior PM rupture. Emergency mitral transcatheter edge-to-edge repair (M-TEER) was performed under intra-aortic balloon pump support. During the procedure, after administration with 1 mg of epinephrine to treat hemodynamic instability, partial rupture of anterior PM occured again, resulting in increased regurgitation in area A1. The rotated 270° grasp technique was applied for bilateral PM rupture, and the severe MR decreased to a mild level.
Discussion:
In patients with severe MR caused by acute myocardial ischemia, positive inotropic agents should be applied cautiously because they may further exacerbate mechanical complications.
Take-Home Messages:
Bilateral PM rupture during M-TEER is extremely rare. The rotated 270° grasp technique can further enhance the success rate of emergency M-TEER.
Related Concept Videos
Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Pneumothorax-I
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
Pneumothorax II: Pathophysiology
Hiatal Hernia

