Summary:The sensitivity of transthoracic echocardiography to visualize the structural abnormality of papillary muscle rup ture (PMR) after acute myocardial infarction can be anticipated to average about 50%; therefore, we evaluated five patients exhibiting the condition with both transthoracic and transesophageal echocardiography. The use of the two imaging techniques resulted in the fact that no instance of PMR was missed. Using transthoracic echocardiography in two patients and transesophageal echocardiography in four, the ruptured papillary muscle was visualized directly. Mitral insufficiency as an indirect sign was observed in all patients. In one patient the papillary muscle rupture developed in a mitral valve previously affected by endocarditis. All patients underwent mitral valve replacement and coronary artery bypass grafting. The diagnosis was confirmed at surgery in all patients. Four patients died in hospital, the fifth 5 months later. We recommend that transesophageal echocardiography be performed in patients with suspected PMR if transthoracic echocardiography does not provide an unequivocal diagnosis.Key words: papillary muscle rupture, myocardial infarction, echocardiography, transesophageal echocardiography IntmductionThe incidence of papillary muscle rupture (PMR) in acute myocardial infarction is found to be 0.9%,' and averages up to 5% in fatal myocardial infarctions? This complication can de-*This paper contains parts of the doctoral thesis of Guido Dohmen.
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