Chronic papillary muscle rupture, a case report

Papillary muscle rupture is a rare and potentially fatal complication of acute myocardial ischemia, which typically results in acute severe mitral regurgitation and cardiogenic shock. Due to the urgent need for medical and surgical intervention and high mortality, chronic presentation of mitral regurgitation from papillary muscle rupture is unusual and, to our knowledge, with no reported incidence.

A 70-year-old female presented with several months of increased fatigability and dyspnea on exertion. Examination and diagnostic echocardiographic studies confirmed severe mitral regurgitation with posterior mitral leaflet prolapse of P2 with suspected papillary muscle attached. Cardiac catheterization showed 80% ostial and 90% proximal stenosis of a diagonal artery branch. Bioprosthetic mitral valve replacement was performed with coronary bypass. Patient had an uneventful postoperative course and symptom-free recovery.

We report a rare case of chronic presentation of severe mitral regurgitation from ruptured papillary muscle, presenting as progressive worsening symptoms. Careful echocardiographic examination and high index of suspicion are keys to diagnosis. Surgical mitral valve replacement is the most common operation done for mitral valve regurgitation secondary to ruptured papillary muscle, with alternatives as surgical mitral valve repair, or percutaneous mitral valve interventions in selected population.