Surgical Treatment for Papillary Muscle Rupture after Myocardial Infarction with Sustained Ventricular Tachycardia

(Department of Cardiovascular Surgery Higashitakarazuka Satoh Hospital, Takarazuka, Japan)

Katsukiyo Kitabayashi Keiwa Kin Takashi Shibuya
Hisashi Satoh
We report an operative case of papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia. A 56-year-old man referred to our emergency room in shock. Emergency CAG showed total occlusion of the left circumflex artery, in which we placed a metallic stent. Even after re-canalization of the coronary artery was achieved, circulation was unstable. IABP and PCPS were used to maintain the systemic circulation. Trans-esophageal echocardiography showed papillary muscle rupture and massive mitral regurgitation. Under total cardiopulmonary bypass and cardiac arrest, we performed mitral valve replacement with a 27mm SJM mechanical valve. PCPS was continued after surgical treatment because of pulmonary congestion. Since the patientfs circulation and respiratory function improved, PCPS and IABP were removed on postoperative days 3 and 5. However, after removal of IABP, ventricular tachycardia appeared and IABP, PCPS were re-inserted. After adequate medication with Amiodarone and Carbedirol, ventricular tachycardia was controlled. PCPS and IABP were then removed uneventfully on postoperative days 14 and 19.
@Jpn. J. Cardiovasc. Surg. 37: 140-143 (2008)