title: Papillary muscle perfusion pattern. A hypothesis for ischemic papillary muscle dysfunction.
abstract: BACKGROUND
  The pathogenesis of posterior papillary muscle dysfunction is poorly understood. We hypothesized that papillary muscle perfusion pattern may explain the higher prevalence of posterior papillary muscle dysfunction after myocardial infarction.
  
  
  RESULTS
  Twenty patients were monitored by transesophageal echocardiography during coronary surgery. Superselective coronary graft injections of 0.2 to 0.5 mL of sonicated albumin microbubbles were performed to assess graft patency and papillary muscle perfusion. Thirty-five graft injections were analyzed: 13 in the right coronary artery, 15 in an obtuse marginal branch, 1 in the left anterior descending coronary artery, and 6 in the first diagonal branch. The posterior papillary muscle was opacified in 16 patients, 11 from the right coronary artery and 5 from one obtuse marginal branch. In 10 of 16 patients (63%), the papillary muscle was perfused by one vessel, while in 6 of 16 (37%), it was perfused by two vessels. The anterior papillary muscle was opacified in 14 patients. Ten patients (71%) had double-vessel and 4 (29%) had single-vessel supply. In the subgroup of 10 patients with old inferior myocardial infarction, mitral regurgitation was present only among those 6 with single rather than double blood supply (P < .05).
  
  
  CONCLUSIONS
  Myocardial infarction may cause papillary muscle dysfunction when the blood supply is provided by one rather than two vessels, as is more frequently the case with the posterior rather than the anterior papillary muscle.
authors.affiliation: Institute of Cardiac Surgery, La Sapienza University of Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Voci
authors.forename: F
authors.initials: F
authors.lastname: Bilotta
authors.forename: Q
authors.initials: Q
authors.lastname: Caretta
authors.forename: C
authors.initials: C
authors.lastname: Mercanti
authors.forename: B
authors.initials: B
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D010210:Papillary Muscles / Q000000981:diagnostic imaging* / Q000503:physiopathology*