Echocardiography in the diagnosis of complete papillary muscle rupture following acute myocardial infarction

Background: Papillary muscle rupture following acute myocardial infarction leads to rapid deterioration of the clinical condition of the patient and eventually to death. A case of complete posterior papillary
muscle rupture is reported.
Case Report: A 45-year-old man with acute inferoposterior myocardial infarction was admitted to the hospital for severe heart failure. Transthoracic echocardiography indicated suspicion of posterior
papillary muscle rupture. Transesophageal Doppler echocardiography definitely pointed to the
diagnosis of complete posterior papillary muscle rupture with concomitant severe (+4) mitral
regurgitation. Left ventriculography confirmed the diagnosis of severe mitral regurgitation.
Coronary angiography demonstrated significant stenosis of the circumflex coronary artery,
first obtuse marginal coronary artery, right coronary artery, and occlusion of the second obtuse
marginal coronary artery. Combined mitral valve replacement (Carbomedics M 27) and coronary
artery bypass grafting (venous graft to the circumflex coronary artery) were performed without
complication.
Conclusions: Transesophageal Doppler echocardiography as an accurate and rapid diagnostic method and
coronary angiography are mandatory before making any therapeutic decision.

Keywords: papillary muscle, Mitral Valve, Rupture, acute myocardial infarction, Echocardiography