Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle

ABSTRACT Acute ischemic mitral regurgitation is due to complete or partial rupture of either anterolateral or posteriomedial papillary muscles occurring within a week of acute myocardial infarction. Chronic ischemic mitral regurgitation is due to postinfarct remodeling leading to imbalance between tethering and closing forces of mitral valve apparatus. We present a 64-year-old male, presenting with acute pulmonary edema secondary to severe mitral regurgitation, a week after his myocardial infarction. Transthoracic echocardiogram detected a mobile intracardiac mass near anterior mitral leaflet with no clear-cut intracardiac origin of this mass. Perioperative transesophageal echocardiography detected rupture of one of the heads of posteriomedial papillary muscle. This case illustrates a rare presentation of postinfarct rupture of one of the heads of posteriomedial papillary muscle occurring late after infarction presenting as an intracardiac mass, which can have surgical implications. How to cite this article Panduranga P. Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle. J Perioper Echocardiogr 2014;2(1)29-31.

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Impact of Papillary Muscle Infarction on Ischemic Mitral Regurgitation Assessed by Magnetic Resonance Imaging

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/s-0043-115121 ◽

2017 ◽

Vol 190 (01) ◽

pp. 42-50 ◽

Cited By ~ 1

Author(s):

Christiane Bretschneider ◽

Hannah-Klara Heinrich ◽

Achim Seeger ◽

Christof Burgstahler ◽

Stephan Miller ◽

...

Keyword(s):

Myocardial Infarction ◽

Mitral Regurgitation ◽

Left Ventricular Function ◽

Ventricular Function ◽

Papillary Muscle ◽

Left Ventricular ◽

Ischemic Mitral Regurgitation ◽

Chronic Myocardial Infarction ◽

End Diastolic Volume ◽

Significant Difference

Objective Ischemic mitral regurgitation is a predictor of heart failure resulting in increased mortality in patients with chronic myocardial infarction. It is uncertain whether the presence of papillary muscle (PM) infarction contributes to the development of mitral regurgitation in patients with chronic myocardial infarction (MI). The aim of the present study was to assess the correlation of PM infarction depicted by MRI with mitral regurgitation and left ventricular function. Methods and Materials 48 patients with chronic MI and recent MRI and echocardiography were retrospectively included. The location and extent of MI depicted by MRI were correlated with left ventricular function assessed by MRI and mitral regurgitation assessed by echocardiography. The presence, location and extent of PM infarction depicted by late gadolinium enhancement (LGE-) MRI were correlated with functional parameters and compared with patients with chronic MI but no PM involvement. Results PM infarction was found in 11 of 48 patients (23 %) using LGE-MRI. 8/11 patients (73 %) with PM infarction and 22/37 patients (59 %) without PM involvement in MI had ischemic mitral regurgitation. There was no significant difference between location, extent of MI and presence of mitral regurgitation between patients with and without PM involvement in myocardial infarction. In 4/4 patients with complete and in 4/7 patients with partial PM infarction, mitral regurgitation was present. The normalized mean left ventricular end-diastolic volume was increased in patients with ischemic mitral regurgitation. Conclusion The presence of PM infarction does not correlate with ischemic mitral regurgitation. In patients with complete PM infarction and consequent discontinuity of viable tissue in the PM-chorda-mitral valve complex, the probability of developing ischemic mitral regurgitation seems to be increased. However, the severity of mitral regurgitation is not increased compared to patients with partial or no PM infarction. Key points Citation Format

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A Coronary Conundrum: Papillary Muscle Rupture and Ischemic Mitral Regurgitation Secondary to Coronary Thromboembolism in Antiphospholipid Syndrome

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709619842247 ◽

2019 ◽

Vol 7 ◽

pp. 232470961984224

Author(s):

Amar Shere ◽

Pradyumna Agasthi ◽

Farouk Mookadam ◽

Sudheer Konduru ◽

Reza Arsanjani

Keyword(s):

Myocardial Infarction ◽

Mitral Regurgitation ◽

Antiphospholipid Syndrome ◽

Papillary Muscle ◽

Rare Complication ◽

Autoimmune Disorder ◽

Ischemic Mitral Regurgitation ◽

Papillary Muscle Rupture ◽

Muscle Rupture ◽

Uncommon Case

Antiphospholipid syndrome (APS) is an autoimmune disorder that has a strong propensity for a hypercoagulable state and is known to be associated with venous and arterial thromboembolism. We describe an uncommon case of APS in the setting of non-Hodgkin’s lymphoma, with thromboembolism, and a rare complication after an uncommon etiology of myocardial infarction. This case highlights the importance of early and appropriate type of anticoagulation to reduce the morbidity and mortality in patients with APS.

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