Acute Anterolateral Papillary Muscle Rupture Following Successful Percutaneous Coronary Intervention and Emergent Mitral Valve Replacement

(Department of Cardiovascular Surgery, Ishinkai Yao General Hospital, Yao, Japan)

Toshiyuki Kuwata Kazumi Mizuguchi Yoichi Kameda
Toru Mori
A72-year-old woman complaining of orthopnea was admitted with cardiogenic shock. Her systolic blood pressure was only 66mmHg and electrocardiogram showed high lateral myocardial infarction. Transthoracic echocardiogram showed severe mitral regurgitation and disruption of the anterolateral papillary muscle. After orotracheal intubation and intraaortic balloon pumping (IABP), coronary angiogram was performed and an occlusion of the entrance of circumflex artery (11) was diagnosed. Percutaneous coronary intervention was done successfully and emergency mitral valve replacement was performed using a St. Jude Medical prosthetic valve preserving the posterior mitral valve leaflet and mitral apparatus. Her postoperative recovery was entirely uneventful and she was followed up as an outpatient. Acute anterolateral papillary muscle rupture is a rare complication of acute myocardial infarction (AMI), although left coronary artery disease is associated with it and immediate recanalization is an important issue to rescue the patient.
@Jpn. J. Cardiovasc. Surg. 34: 144-147 (2005)