title: A survival case of acute mitral regurgitation and cardiogenic shock caused by subtotal occlusion of the first diagonal branch.
abstract: An 80-year-old woman was admitted with cardiogenic shock; she arrived in a deep coma with systolic blood pressure of 44 mmHg. An electrocardiogram showed ST elevation in I, aVL, V5 and V6, suggesting myocardial infarction in the lateral area of the left ventricle. A chest roentgenogram showed right pulmonary edema without cardiomegaly. Transthoracic and transesophageal echocardiograms revealed severe mitral regurgitation and a flailing anterior mitral valve leaflet, suggesting a ruptured papillary muscle. The patient was initially treated with high-dose dopamine, dobutamine and norepinephrine. Intraaortic balloon pumping was initiated after the patient's condition stabilized. She underwent emergency mitral valve replacement with a prosthetic valve. Complete rupture of the anterior papillary muscle was confirmed. Histological examination revealed necrosis of the anterior papillary muscle with inflammatory changes. She recovered uneventfully. Postoperative coronary angiography demonstrated subtotal occlusion of the first diagonal branch, and left ventriculography demonstrated akinesis of the lateral segment. This was a rare case in which subtotal occlusion of the first diagonal branch caused rupture of an anterior papillary muscle leading to severe mitral regurgitation.
authors.affiliation: Division of Cardiology, International Medical Center of Japan, Tokyo.
authors.forename: Tohru
authors.initials: T
authors.lastname: Takahashi
authors.forename: Koji
authors.initials: K
authors.lastname: Kohno
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kashida
authors.forename: Toyohiko
authors.initials: T
authors.lastname: Morita
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Akiko
authors.initials: A
authors.lastname: Kamei
authors.forename: Yujong
authors.initials: Y
authors.lastname: Seo
authors.forename: Itta
authors.initials: I
authors.lastname: Kawamura
authors.forename: Taro
authors.initials: T
authors.lastname: Kojima
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Seki
authors.forename: Kan
authors.initials: K
authors.lastname: Saito
authors.forename: Kenta
authors.initials: K
authors.lastname: Kumagai
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Ohno
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Itaoka
authors.forename: Osamu
authors.initials: O
authors.lastname: Okazaki
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Izumo
authors.forename: Sosuke
authors.initials: S
authors.lastname: Kimura
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Akatsuka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003128:Coma; D017023:Coronary Angiography; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology / Q000601:surgery; D010210:Papillary Muscles / Q000473:pathology; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome