Papillary muscle rupture following acute myocardial infarction: Anatomic, echocardiographic, and surgical insights

Abstract

Papillary muscle (PM) rupture is a rare complication of acute myocardial infarction which carries an excessive mortality rate. Optimal outcomes require rapid diagnosis and prompt surgical referral, and in this regard, echocardiography plays a crucial role. Comprehensive echocardiographic examination of the patient with PM rupture consists of identification of the ruptured PM segment, visualization of flail mitral valve segment(s), evaluation of mitral regurgitation severity, and assessment of left ventricular systolic function. This article discusses anatomic and echocardiographic features as well as the surgical management of PM rupture.

Is it septic or cardiogenic shock? Papillary muscle rupture masquerading as sepsis

“…Unilateral pulmonary edema (UPE) is a rare entity that can be mistaken for other causes of unilateral infiltrate on chest radiography, especially pneumonia. Mitral regurgitation jets associated with anterolateral PMR course medially before turning to the right pulmonary vein (PV) . It is likely that the UPE on the CXR was the result of the increased pressures due to regurgitant jet on particularly the superior right PV as was demonstrated in our case (Figure ; https://www.youtube.com/playlist?list=PLkbB_FbbAwG6mG2D951kfigemL-H4kBTz).…”

“…Transthoracic echocardiogram remains critical in the diagnosis of PMR with a sensitivity of 65–93% . The sensitivity of TTE is improved with the use of colour flow Doppler …”

Rupture of mitral valve papillary muscle: a rare complication following myocardial infarction

“…Risk of mechanical complications (such as papillary muscle infarction) has therefore dramatically decreased. Incidence of papillary muscle rupture has been previously reported at 1% but given the uptake of primary PCI, it has now been reported at 0.25% 2 8…”

“…The anterolateral papillary muscle has a dual blood supply from both left anterior descending and left circumflex arteries making it less prone to rupture in contrast to posteromedial papillary muscle which has a single blood supply from either the left circumflex or right coronary (depending on which is dominant) and hence more prone to rupture. It is important to note that each papillary muscle supplies chords to the ipsilateral half of both mitral valve leaflets 2…”

A Case Report: In-hospital acute papillary muscle rupture in SARS-COV 2 positive patient late after acute inferior myocardial infarction

“…82% of patients with first myocardial infarction were reported to have papillary muscle rupture. 3,4 Echocardiography with Doppler is the cornerstone for the diagnosis of this fatal complication. The sensitivity of TTE to visualize the structural abnormalities has been estimated to be 65-85%, with transesophageal echo sensitivity approaching 92-100%.…”