Dissecting Thoracic Aorta: A Split Decision Making

Abstract

carditis. On September 14, 2004, the patient underwent repeat cardiac surgery. The intraoperative findings included 1) a potential space between the sewing ring and the annulus; 2) the suspected prosthetic mitral valve mass was identified as a previously preserved primary chord to the anterior leaflet, which had a small portion of papillary muscle attached to it. This was prolapsing into the left ventricular outflow tract through the aortic valve. The surgeon performed a primary repair of the paravalvular leak and excision of the residual anterior leaflet chordae with attached papillary muscle. The papillary muscle presumably ruptured and resulted in its prolapse into the left ventricular outflow tract through the aortic valve. Pathology demonstrated infarcted papillary muscle tissue attached to chordae consistent with the contention of a ruptured papillary muscle.