Transcatheter aortic valve implantation complicated by papillary muscle rupture with a good final outcome

Papillary muscle rupture after transcatheter aortic valve implantation: A case report and literature review

“…3 Conservatively treated patients remained symptomatic. 3,5,7 Both surgical mitral valve replacement and minimally invasive mitral repair seem to be effective in treatment of the resulting severe mitral regurgitation. The postulated mechanism of papillary muscle rupture during TAVI is papillary muscle injury with a guidewire/delivery system or balloon nose cone during valve implantation.…”

“…Three patients were males, 2 were females while the gender of the last patient was not mentioned. The median age was 85 years (range: 82−89 years), a small hypertrophied left ventricle was described in 4 cases (67%) 3–5,7 and mitral annular calcification in 2 cases (33%) 2,7 associated with papillary muscle head calcification in 1 of them 2 . Accessory mitral valve tissue projecting in left ventricular outflow tract in combination with small left ventricle was the anatomical substrate in 1 case 5 …”

“…[8][9][10] We found 6 cases in the literature. [2][3][4][5][6][7] These are summarized in Table 1. Three patients were males, 2 were females while the gender of the last patient was not mentioned.…”

“…The postulated mechanism of papillary muscle rupture during TAVI is papillary muscle injury with a guidewire/delivery system or balloon nose cone during valve implantation. [2][3][4][5][6][7] Notably, papillary muscle injury may be incomplete and progresses to a complete rupture few hours to months after TAVI, 4,5 probably influenced by a reverse remodeling with improvement of the left ventricular contractility. Small hypertrophied left ventricle is a common finding in these patients.…”

“…1 Peri-TAVI papillary muscle rupture is a rare complication that has been also reported. [2][3][4][5][6][7] We report a case of an 87-year-old man who developed severe mitral regurgitation on top of posterior papillary muscle rupture following TAVI and review similar documented cases in the literature through December 2022. We aim to increase the awareness about this rare complication, emphasize the importance of periprocedural echocardiography, and identify possible patient and procedure related risk factors for papillary muscle rupture after TAVI.…”