title: Papillary muscle rupture following acute myocardial infarction.
abstract: OBJECTIVE
  Papillary muscle rupture following acute myocardial infarction (AMI), which rarely occurs, leads to catastrophic outcomes. We reviewed 6 patients who were diagnosed as having papillary muscle rupture.
  
  
  METHODS
  Between February 1986 and September 2002, 6 consecutive patients underwent mitral valve replacement (MVR) for acute mitral regurgitation due to postinfarction papillary muscle rupture (4 men and 2 women, mean age 67 years). Preoperatively, all were in New York Heart Association (NYHA) class IV. All patients had intraaortic balloon pumping, and one needed additional percutaneous cardiopulmonary support. Operations were performed within 1 to 19 days (mean 6.8) after the onset of AMI, and within 24 hours after papillary muscle rupture. Complete ruptures were found in 5 of 6 patients. Four patients had posterior papillary rupture and 2 patients anterior. All patients underwent MVR to preserve the posterior mitral leaflet. Concomitant coronary artery bypass grafting was performed in 5 of 6 patients (mean 1.6 grafts per person) and pulmonary venous isolation for atrial fibrillation in one patient.
  
  
  RESULTS
  The cardiopulmonary bypass time ranged from 178 to 325 minutes (mean 236), and the aortic cross clamp time from 123 to 196 minutes (mean 155). Two patients died of low cardiac output syndrome. Of 4 operative survivors, 3 patients were in NYHA class I and one in class II. The mean follow-up term was 21 months. One patient with the pulmonary venous isolation has been in sinus rhythm. All survivors have been doing well without any valve related complications.
  
  
  CONCLUSIONS
  Six patients underwent MVR for the papillary muscle rupture following AMI and the perioperative mortality rate was 33%. All survivors have been well with no cardiac events. We propose that in papillary muscle rupture following AMI emergent surgery should be undertaken as soon as possible, and that concomitant surgery should be performed as thoroughly as possible.
authors.affiliation: Department of Cardiovascular Surgery, Himeji Cardiovascular Center, Himeji, Hyogo, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Minami
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Mukohara
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Obo
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshida
authors.forename: Keitaro
authors.initials: K
authors.lastname: Nakagiri
authors.forename: Tomoki
authors.initials: T
authors.lastname: Hanada
authors.forename: Ayako
authors.initials: A
authors.lastname: Maruo
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsuhisa
authors.forename: Naoto
authors.initials: N
authors.lastname: Morimoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D009202:Cardiomyopathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D009203:Myocardial Infarction / Q000150:complications*; D010210:Papillary Muscles; D012422:Rupture, Spontaneous; D016896:Treatment Outcome