A Case of Mitral Valve Replacement for Mitral Regurgitation Induced by Direct Insertion of the Papillary Muscle into the Anterior Mitral Leaflet with Postinflammatory Disease

Ryuji Higashita Seiichi Ichikawa
Hiroshi Niinami Tetsuo Ban
Yuji Suda Hidetsugu Ogasawara
Yasuo Takeuchi Shin-ichiro Ohkawa

(Department of Cardiovascular Surgery and Department of Internal Medicine, Tokyo Women's Medical University Daini Hospital, Tokyo, Japan)

A 71-year-old man had been repeatedly admitted to our hospital with congestive heart failure, cerebral infarction and pneumonia. Under a diagnosis of mitral regurgitation and tricuspid regurgitation by echocardiography and catheter examination, mitral valve replacement and tricuspid annuloplasty were performed. Pathohistological study revealed a direct insertion of the papillary muscle into the anterior mitral leaflet (DPM) in addition to post-rheumatic valvular disease. These findings suggest that the increased rigidity of the scarring valve leaflets in combination with direct insertion of DPM lead to inadequate leaflet coaptation and apposition. This is the first report of mitral valve replacement for mitral regurgitation due to postinflammatory valvular disease with DPM.@
@@Jpn. J. Cardiovasc. Surg. 31: 156-159 (2002)