Eur J Cardiothorac Surg 2000;18:607
© 2000 Elsevier Science NL
Images in cardio-thoracic surgery |
Ruptured papillary muscle
Donald Oxorna,
William Curtisb,
Robert Burnettb
a Department of Anesthesiology, University of Washington Medical Center, Box 356540, Seattle, WA 98195-6540, USA
b Department of Surgery, University of Washington Medical Center, Box 356540, Seattle, WA 98195-6540, USA
Received 2 September 2000;
received in revised form 5 September 2000;
accepted 5 September 2000.
Corresponding author
e-mail: oxorn{at}u.washington.edu
Key Words: Intra aortic balloon pump • Papillary muscle • Triple coronary bypass
The patient, a 64–year–old male, presented to hospital because of ongoing chest pain. He was endotracheally intubated because of hypoxemic respiratory failure, and taken to the cardiac catheterization suite where his circumflex coronary artery was stented and an intra aortic balloon pump (IABP) inserted. Because moderate mitral regurgitation was noted, a transesophageal echocardiogram was subsequently performed. Findings included an akinetic inferior wall, rupture of the postero-medial papillary muscle, and a flail anterior mitral leaflet. (Fig. 1A)
. The following day the patient was taken to the operating room. The mitral valve was exposed through a right atrial incision, and the ruptured papillary muscle identified (Fig. 1B). The native mitral valve was excised and a 31 mm St. Jude's mechanical mitral prosthesis inserted. A triple coronary bypass was performed. The following day the patient was extubated and the IABP removed. He has made a satisfactory recovery.
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Fig. 1. (A) TEE showing the ruptured head of the postero-medial papillary muscle and attached chord. (B) Pathologic specimen.
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