title: [Early papillary muscle rupture in myocardial infarction, diagnosis with transesophageal echography].
abstract: We describe the case of posterior papillary muscle (PPM) rupture with severe mitral regurgitation at the very beginning of an inferior myocardial infarction (MI) in a 79-year-old woman. The diagnosis was made by transesophageal echocardiography (TEE) and confirmed at autopsy. This case confirms the value of TEE in diagnosing PPM rupture and the association of PPM rupture with small posterior myocardial infarction. Moreover the case presents some unusual aspects: the rupture occurred very early; at transthoracic approach, a systolic convergence flow zone was the only sign of mitral regurgitation by color flow mapping; at TEE flail mitral leaflets were absent; in systole, the trunked papillary muscle did not prolapse into the left atrial cavity, but crushed into the atrial side of posterior mitral leaflet, remaining at the atrioventricular level; at autopsy, there was a split PPM with a completely ruptured medial branch. On the atrial side of the posterior mitral leaflet there was an ecchimothic zone, due to the crushing of the PPM.
authors.affiliation: Divisione di Cardiologia, Ospedale S Carlo Borromeo, Milano.
authors.forename: F
authors.initials: F
authors.lastname: Casazza
authors.forename: D
authors.initials: D
authors.lastname: Malaspina
authors.forename: C
authors.initials: C
authors.lastname: Montaperto
authors.forename: A
authors.initials: A
authors.lastname: Bongarzoni
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging*; D006801:Humans; D010210:Papillary Muscles / Q000000981:diagnostic imaging*; D013997:Time Factors
vernacular_title: Rottura precoce di muscolo papillare in corso di infarto miocardico, diagnosi con ecografia transesofagea.