An unusual presentation of ischaemic mitral regurgitation as P2 prolapse

Perfusion ◽  
2017 ◽  
Vol 32 (8) ◽  
pp. 706-708
Author(s):  
David S. Thompson ◽  
Prakash P. Punjabi
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Pulmonary Oedema ◽  
Papillary Muscle ◽  
Myocardial Ischaemia ◽  
Severe Mitral Regurgitation ◽  
Circumflex Coronary Artery ◽  
Complete Occlusion ◽  
Acute Mitral Regurgitation ◽  
Obtuse Marginal

A 54-year-old gentleman presented with pulmonary oedema secondary to anterolateral papillary muscle (PPM) rupture and acute mitral regurgitation subsequent to myocardial ischaemia (MI). Angiography revealed complete occlusion of the first obtuse marginal (OM1) branch of the circumflex coronary artery and a 70% occlusion of the left anterior descending (LAD) coronary artery. Operatively, unusual anatomy was noted; an accessory head was attached superiorly to the anterior lateral PPM. This gave rise to chordae that were subsequently attached to the posterior second (P2) scallop. Additionally, the P2 scallop was deficient in chordae from the posteromedial PPM, thus, loss of this accessory head led to severe mitral regurgitation. We review the PPM anatomy and pathological context of PPM rupture and ischaemic mitral regurgitation.

scholarly journals Papillary muscle head rupture in a patient with normal coronarography findings

2007 ◽  
Vol 64 (4) ◽  
pp. 275-278
Author(s):  
Andrijana Kostic-Mirkovic ◽  
Srdjan Pavicevic ◽  
Ivan Otasevic ◽  
Sergej Radovic ◽  
Tomislav Marenovic
Keyword(s):  
Mitral Regurgitation ◽  
Pulmonary Oedema ◽  
Papillary Muscle ◽  
Clinical Status ◽  
Posterior Leaflet ◽  
Papillary Muscle Rupture ◽  
General Weakness ◽  
Vital Interest ◽  
Acute Mitral Regurgitation ◽  
Time Of Admission

Background. Rupture of papillary muscle generally happens during acute myocardial infarction and is the cause of acute mitral regurgitation, pulmonary oedema, so it should be promptly recognized and managed. Case report. A patient, 52 year-old, was admitted to the Thoracic Department with fever, general weakness, dyspnea and cough as a case of suspected pneumonia. Two days before the admission he was treated with antibiotics. At thoracic ward, his clinical status got serious and he transferred to Intensive Care Unit (ICU) as pulmonary oedema. At the time of admission to ICU the patient was seriously ill with tachycardia, tachydyspnea, orthopnea and cyanosis image. Auscultatory, he showed pulmonal stasis at both sides and a tachyarrhythmic action, with a systolic murmur 5/6 grade above the mitral valve. Echocardiography showed grave mitral regurgitation with prolapsus of posterior leaflet with suspected chordal rupture. At coronarography no significant lesions of coronary arteries were found. After hemodynamic stabilization the patient was operated. During the operation, Transesophageal echocardiography (TEE) examination showed a rupture of the head of the posteromedial papillary muscle. He was surgically treated with atypical quadrantectomy of posterior leaflet with homologous pericardial patch anuloplasty. Conclusion. The recognition of acute mitral regurgitation caused by the papillary muscle rupture and prompt surgical treatment is of vital interest for the survival of patients.

Acute Mitral Regurgitation: an important cause of respiratory distress

2016 ◽  
Vol 15 (1) ◽  
pp. 30-32
Author(s):  
Legate Philip ◽  
◽  
Neil Andrews ◽  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Respiratory Distress ◽  
Severe Mitral Regurgitation ◽  
Shortness Of Breath ◽  
Valve Repair ◽  
X Ray ◽  
Clinical Presentations ◽  
Acute Mitral Regurgitation ◽  
Chest X Ray

Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Failure to respond to antibiotic treatment following 3 weeks on ITU led to the consideration of acute MR as the cause of his symptoms and he responded well to diuretics. He subsequently underwent mitral valve repair. The causes and clinical presentations of this condition are discussed.

Effects of exercise on collateral development in myocardial ischemia in pigs

1984 ◽  
Vol 56 (3) ◽  
pp. 656-665 ◽  
Author(s):  
C. M. Bloor ◽  
F. C. White ◽  
T. M. Sanders
Keyword(s):  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Exercise Training ◽  
Collateral Circulation ◽  
Coronary Artery Stenosis ◽  
Arterial Stenosis ◽  
Collateral Flow ◽  
Circumflex Coronary Artery ◽  
Complete Occlusion ◽  
Collateral Development

To study the effects of exercise on collateral development in myocardial ischemia, we induced coronary arterial stenosis of the left circumflex coronary artery (LCCA) in 18 of 30 pigs. During that surgery, we identified the coronary bed at risk. Nine of these pigs were then subjected to 5 mo of exercise training on a treadmill. After exercise training, we determined regional collateral and myocardial blood flow using radiolabeled microspheres. At autopsy, all animals had complete occlusion of the LCCA. Infarct size in the exercise-trained pigs was significantly less than in the sedentary pigs (5.9 +/- 1.0 vs. 11.7 +/- 1.0% of the left ventricle). The exercise-trained animals had a greater increase in collateral flow, 35.1 +/- 3.0 vs. 28.7 +/- 4.1 ml X min-1 X 100 g-1, in the noninfarcted jeopardized zone of the LCCA bed. The major findings of the study were the following: 1) chronic coronary artery stenosis progressing to occlusion stimulated development of the collateral circulation and salvaged tissue in the jeopardized myocardium of an animal model with sparse collaterals; 2) development of the collateral circulation and tissue salvage is increased by exercise training; 3) collaterals develop primarily in or near the ischemic zone; and 4) all collateral beds develop a circumferential flow gradient following occlusion.

scholarly journals Acute severe mitral regurgitation: consideration of papillary muscle architecture

2008 ◽  
Vol 6 (1) ◽  
Author(s):  
Andrew Czarnecki ◽  
Amar Thakrar ◽  
Tielan Fang ◽  
Matthew Lytwyn ◽  
Roien Ahmadie ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Muscle Architecture ◽  
Severe Mitral Regurgitation
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