Isolated Acute Anterolateral Papillary Muscle Rupture Presenting as a Sole Manifestation of Acute Myocardial Infarction and Mimicking Mitral Valve Vegetation

Moustapha, Ali; Lyngholm, Karen; Barasch, Eddy

doi:10.1159/000047387

Cited by 6 publications

(4 citation statements)

References 7 publications

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“…The pathognomonic echocardiographic finding of acute PMR is the prolapse of the ruptured papillary muscle head attachment to the flail mitral leaflet into the left atrium. However, TTE may be not informative in patients with partial PMR or ruptured heads that do not prolapse into the left atrium (up to 35% of cases with acute PMR), which could be mistaken for a valvular tumor, thrombus, or vegetation [ 11 ]. TTE has a diagnostic sensitivity of 65% to 85% [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Anterolateral Papillary Muscle Rupture Predicted by Post-Infarction Inflammatory Markers

2023

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Patient: Female, 72-year-old Final Diagnosis: Anterolateral papillary muscle rupture Symptoms: Discomfort • nausea • sweating Clinical Procedure: — Specialty: Cardiology • Genetics Objective: Rare coexistence of disease or pathology Background: The incidence of papillary muscle rupture (PMR), a mechanical complication of acute myocardial infarction, has decreased in the reperfusion era; however, its fatality rate remains high. Timely recognition and prompt initiation of treatment for PMR are important to avoid prolonged cardiogenic shock; however, the symptoms of PMR are nonspecific, and early diagnosis is often difficult. Case Report: A 72-year-old woman with nausea for 2 days presented with ST-segment elevation myocardial infarction with obstruction of the obtuse marginal branch and 75% stenosis of the first diagonal branch. Percutaneous coronary intervention was performed to revascularize the obtuse marginal lesion, which was over thrombolysis in myocardial infarction grade 2 flow. After percutaneous coronary intervention, the patient developed fever, an elevated C-reactive protein level, and an increased neutrophil-to-lymphocyte ratio (NLR). The patient showed no signs of infection but elevated inflammatory marker levels, with C-reactive protein rising to 39.32 mg/dL and NLR to 15. On postoperative day 4, the patient’s clinical condition rapidly deteriorated, resulting in circulatory failure. Transthoracic echocardiography showed anterolateral PMR, and urgent surgical mitral valve replacement was performed. On day 32, the patient was discharged from the hospital, and at the 1-year follow-up, she remained in good health. Conclusions: When there are multiple lesions, including the obtuse marginal and diagonal branches, anterolateral PMR should be suspected as the cause of cardiogenic shock. Performing point-of-care echocardiography and closely monitoring C-reactive protein levels and NLR can be helpful to detect PMR early.

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Section: Discussionmentioning

confidence: 99%

Anterolateral Papillary Muscle Rupture Predicted by Post-Infarction Inflammatory Markers

2023

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“…Transthoracic echocardiography showed severe mitral regurgitation (MR), resulting from mitral valve prolapse, with normal left ventricular regional and systolic function. Hematologic evaluation revealed a hemoglobin value of 19.9 g/dL and a white blood cell count of 28400/mm 3 . Biochemical values included an elevated creatine kinase level of 1133 U/L, a CK-MB level of 136 U/L, an aspartate aminotransferase level of 129 U/L, and a lactate dehydrogenase level of 547 U/L.…”

Section: Case Reportmentioning

confidence: 99%

Acute Mitral Valve Regurgitation due to Complete Rupture of Anterior Papillary Muscle Mimicking Mitral Valve Vegetation

Tsutsumi

Monta

Kato

et al. 2011

ATCS

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We report the successful treatment of a 77-year-old man after a difficult diagnosis of mitral valve regurgitation resulting from complete rupture of the anterior papillary muscle. The patient with cardiogenic shock was an emergency admission. An electrocardiogram showed acute lateral wall myocardial infarction. He had complications of leukocytosis and a highgrade fever. Transesophageal echocardiography seemed to show the appearance of a large area of vegetation attached to the anterior mitral valve leaflet and aortic non-coronary cusp, resulting in severe mitral regurgitation. We performed coronary angiography, which showed complete obstruction of the circumflex coronary artery. We determined that the condition was caused by infective endocarditis. Emergency surgery showed the complete rupture of the anterior papillary muscle, but there was no vegetation. The mitral valve was replaced with a bioprosthetic valve and the circumflex coronary artery was bypassed with a saphenous vein graft. Pathological examination revealed mitral valve to be non-mycotic, and the postoperative course was uneventful.

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“…Naproti tomu spíše ojediněle publikované práce popisují zkušenosti s touto metodou u ruptury papilárního svalu. (20)(21)(22) Na třech konkrétních případech z naší klinické praxe popisujeme možnosti a získaný dojem z využití RT3D v diagnostice rychle se pohybujících intrakardiálních útvarů. Ty vídáme podstatně méně častěji než útvary přisedlé či jen s omezeným vlastním pohybem a pevným spojením s okolní srdeční tkání.…”

Section: Diskuseunclassified

Three-dimensional echocardiography in the diagnosis of fast-moving intracardiac formations

Fiedler¹,

Linhartová²,

Blaško³

et al. 2008

Cor Vasa

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Echokardiografie je rutinně používanou metodou také v diagnostice nitrosrdečních útvarů. Dvourozměrné zobrazení rychle se pohybujících patologických struktur uvnitř srdečních oddílů přináší řadu specifických problémů a limitací. Jejich ne vždy ideální zobrazení při standardním ultrazvukovém vyšetřování doposud představuje určitou výzvu, neboť chybný závěr a nesprávná diagnóza mohou mít pro osud nemocného vážné důsledky. Podle teoretických předpokladů by trojrozměrná echokardiografie v reálném čase mohla mít potenciál některé tyto nedostatky zmírnit či zcela eliminovat. To by zároveň vedlo nejen ke zkrácení potřebného času, ale především ke zpřesnění vyšetřování podobných případů. V souladu s tím informace v literatuře naznačují, že komplexnější zobrazení těchto patologií by mohlo představovat určitý pokrok. Není dosud zcela jasné použití u osob ve vážném stavu, akutních situacích, při aktuální nemožnosti provést vyšetření jícnovou sondou či kontraindikacích k převozu na jinou zobrazovací metodu. Článek popisuje využití této metody na našem pracovišti při stanovení diagnózy u konkrétních pacientů. Jedná se o tři různé klinické jednotky, v běžné praxi v této formě a rozsahu poměrně raritní. Ve všech případech byl použit přístroj SONOS 7 500 a matrixová ultrazvuková sonda X4 (firma Philips, Andover, MA, USA). Klíčová slova: Trojrozměrná echokardiografie-Intrakardiální útvary-Myxom pravé síně-Intrakardiální embolus-Plicní embolie-Systémová trombolýza-Ruptura papilárního svalu

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Isolated Acute Anterolateral Papillary Muscle Rupture Presenting as a Sole Manifestation of Acute Myocardial Infarction and Mimicking Mitral Valve Vegetation

Cited by 6 publications

References 7 publications

Anterolateral Papillary Muscle Rupture Predicted by Post-Infarction Inflammatory Markers

Anterolateral Papillary Muscle Rupture Predicted by Post-Infarction Inflammatory Markers

Acute Mitral Valve Regurgitation due to Complete Rupture of Anterior Papillary Muscle Mimicking Mitral Valve Vegetation

Three-dimensional echocardiography in the diagnosis of fast-moving intracardiac formations

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