Mitral Valve Repair in a Patient with Partial Rupture of the Posterior Papillary Muscle after Acute Myocardial Infarction

(Department of Cardiovascular Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan)

Takeichiro Nakane Takahide Takeda Naoki Kanemitsu
Masaki Aota Yutaka Konishi
Papillary muscle rupture after acute myocardial infarction(AMI)is an infrequent but fatal complication. We report a case of mitral valve repair performed in a patient with partial papillary muscle rupture after AMI. An 85-year-old man was admitted to our hospital for AMI with cardiac shock. Emergency coronary angiography revealed triple-vessel disease, and percutaneous coronary intervention for the culprit lesion of the left circumflex artery was successfully performed. Eleven days after the onset of the AMI, the pulmonary artery pressure abruptly increased to 60 mmHg and a pansystolic murmur was detected. Transesophageal echocardiography showed severe mitral regurgitation(MR)with flail in the A1-A2 region of the anterior mitral leaflet. We demonstrated erratic motion of the ruptured anterior head in the left ventricle, and this was diagnosed as partial rupture of the posterior papillary muscle. Intra-aortic balloon pumping(IABP)was performed to maintain the systemic circulation. Four days after the onset of acute MR(15 days following AMI), we performed mitral valve repair with coronary artery bypass grafting. We reattached the ruptured head to the viable posterior head with pledget sutures and performed annuloplasty using Carpentier-Edwards classical ring M28. Postoperative echocardiography showed no MR, and the patient was uneventfully discharged on the 45th postoperative day.
  Jpn. J. Cardiovasc. Surg. 38:380-384(2009)

Keywords:acute myocardial infarction, papillary muscle rupture, partial papillary muscle rupture, mitral regurgitation, mitral valve repair