Ruptured Papillary Muscle Following Myocardial Infarction with Long Survival

Abstract

Two cases of rupture of a papillary muscle of the left ventricle are presented. We believe that these are the two longest recorded survivals of this complication of acute myocardial infarction. A presumptive clinical diagnosis is possible from the characteristic history of sudden deterioration together with the development of a loud apical systolic murmur. The differential diagnosis and the possibility of corrective surgery in a patient who survives the acute event are discussed.

Papillary muscle rupture following myocardial infarction: Successful treatment by resection of akinetic left ventricular area, mitral valve replacement, and aorta to coronary artery bypass graft

“…Reported cases of papillary muscle rupture complicating myocardial infarction have been reviewed (Davison, 1948;Craddock and Mahe, 1953;Sanders et al, 1957). The sudden development of pulmonary oedema and the emergence of an apical systolic murmur during the first two weeks after the onset of myocardial infarction were found to be characteristic features in the diagnosis of mitral incompetence due to rupture of a papillary muscle (Sanders et al, 1957;Breneman and Drake, 1962;Adicoff et al, 1963). Unless further myocardial infarction occurs, and apart from the subsequent development of left atrial or ventricular strain, electrocardiography was not reported to show specific changes (Breneman and Drake, 1962;Phillips, De Pasquale, and Burch, 1963).…”

“…The sudden development of pulmonary oedema and the emergence of an apical systolic murmur during the first two weeks after the onset of myocardial infarction were found to be characteristic features in the diagnosis of mitral incompetence due to rupture of a papillary muscle (Sanders et al, 1957;Breneman and Drake, 1962;Adicoff et al, 1963). Unless further myocardial infarction occurs, and apart from the subsequent development of left atrial or ventricular strain, electrocardiography was not reported to show specific changes (Breneman and Drake, 1962;Phillips, De Pasquale, and Burch, 1963). Chest films might reveal pulmonary vascular congestion with a near normal left atrial size and normal cardiothoracic ratio (DeBusk et al, 1970;Sanders et al, 1971).…”

“…The sudden occurrence of mitral incompetence in an already damaged left ventricle might lead to fatal pulmonary oedema (Davison, 1948;Craddock and Mahe, 1953;Sanders et al, 1957;Cederqvist and Soderstrom, 1964;Heikkila, 1967). Survival for a longer time, however, albeit with cardiac failure, is possible when the left ventricular function is compromised to a lesser degree or when rupture of the papillary muscle involves one of its heads only (Breneman and Drake, 1962;Adicoff, Alexander, Ferguson, and Kelly, 1963;Horlick, Merriman and Robinson, 1966;de la Torre, Linhart, and Bartley, 1967;Morrow et al, 1968;Braunwald, 1969). In such patients surgical correction of the ensuing haemodynamic abnormalities by mitral valve replacement with or without resection of the ventricular dyskinetic area has been reported (Austen, Sanders, Averill, and Friedlich, 1965;Holloway, Whalen, and McIntosh, 1965;de la Torre et al, 1967;Morrow et al, 1968;deBusk et al, 1970;Hatcher et al, 1970;Schimert et al, 1970).…”

Surgical versus medical management of patients with acute ischemic mitral regurgitation: a systematic review

“…Acute ischemic mitral regurgitation (MR) is seen in patients with myocardial infarction (MI), and is associated with increased morbidity and mortality. Severe MR may occur with a frequency ranging from 0.3 to 3 % [ 1 , 2 ] and is more related to the location of the infarction (more commonly seen with inferior MI) rather than the degree of infarction [ 3 – 7 ]. Left ventricular remodeling, tethering of the mitral valve leaflets, apical displacement of the papillary muscle, and less commonly papillary muscle rupture, contribute to the MR [ 2 , 8 – 10 ].…”