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[A case of mitral regurgitation due to partial papillary muscle rupture whose etiology was unknown]
A Morishita1, K Tsuchiya, S Hosaka
1Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Japan.
Abstract:
The etiology of the papillary muscle rupture includes myocardial infarction, trauma, hypertension, myxomatous degeneration, endocarditis etc. We report a case of partial papillary muscle rupture whose etiology was unknown, in a 77-year-old woman. The preoperative catheterization and coronary angiography showed severe mitral regurgitation and no significant coronary stenosis. And we recognized the mass waving into the left atrium in systole with the echocardiogram. At surgery, we repaired the mitral valve by resecting quadrangular areas of the posterior leaflet including the attachment of the torn papillary muscle. Additionally a number 28 Carpentier-Edwards mitral annuloplasty ring was sewn in place. In pathologic specimen, there were focal fibrosis, necrotic muscle, lymphocytes, and no vegetation.
Insights
This case study details a partial papillary muscle rupture of unknown cause in an elderly woman. Surgical repair of the mitral valve successfully addressed severe mitral regurgitation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Background:
- Papillary muscle rupture is a rare but serious cardiac complication.
- Etiologies include myocardial infarction, trauma, hypertension, myxomatous degeneration, and endocarditis.
- This report focuses on a case with an unknown etiology.
Observation:
- A 77-year-old woman presented with severe mitral regurgitation.
- Preoperative evaluation revealed no significant coronary stenosis but identified a mass in the left atrium via echocardiogram.
- The mass was observed to move into the left atrium during systole.
Findings:
- The patient underwent surgical repair of the mitral valve, involving resection of posterior leaflet tissue and implantation of a mitral annuloplasty ring.
- Pathological examination of the resected tissue showed focal fibrosis, necrotic muscle, and lymphocytes.
- No vegetation was found, ruling out infective endocarditis as the cause.
Implications:
- This case highlights the importance of comprehensive echocardiographic evaluation in diagnosing papillary muscle rupture, even with unclear etiology.
- Successful surgical management can restore mitral valve function.
- Further research may elucidate rarer causes of papillary muscle rupture.