title: Acute severe mitral regurgitation: consideration of papillary muscle architecture.
abstract: We present a case of an individual who presented with acute severe mitral regurgitation in the setting of an inferior ST elevation myocardial infarction. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet attached presumably to the anterior papillary muscle. Intraoperative findings demonstrated rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet. This case serves to remind us that both the anterior and posterior leaflets of the mitral valve are attached to both papillary muscle heads. The direction and eccentricity of the mitral regurgitant jet on echocardiography helps to locate the leaflet involved, but not necessarily the coexisting papillary muscle pathology.
authors.affiliation: Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, Manitoba, Canada. aczarnecki@shaw.ca
authors.forename: Andrew
authors.initials: A
authors.lastname: Czarnecki
authors.forename: Amar
authors.initials: A
authors.lastname: Thakrar
authors.forename: Tielan
authors.initials: T
authors.lastname: Fang
authors.forename: Matthew
authors.initials: M
authors.lastname: Lytwyn
authors.forename: Roien
authors.initials: R
authors.lastname: Ahmadie
authors.forename: Edward
authors.initials: E
authors.lastname: Pascoe
authors.forename: Davinder S
authors.initials: DS
authors.lastname: Jassal
mesh_terms: D000208:Acute Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology*; D009135:Muscular Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D010210:Papillary Muscles / Q000000981:diagnostic imaging*; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging; D014463:Ultrasonography