title: Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease.
abstract: A 48 year old man was transferred to our department with cardiogenic shock, pyrexia, a high white cell count and significant serum troponin T level. Clinical evaluation revealed severe mitral regurgitation secondary to a flail of both mitral valve leaflets. An emergency cardiac catheterisation did not reveal any significant coronary artery disease. Left ventricular angiogram and echocardiography demonstrated a good left ventricular function and massive mitral regurgitation. Blood cultures were negative for aerobics, anaerobics and fungi. The patient underwent emergency mitral valve replacement with a mechanical valve. Intraoperatively, the posteromedial papillary muscle was found to be ruptured. Histology of the papillary muscle revealed myocardial necrosis with no signs of infection. Cultures obtained from a mitral valve specimen were negative. The patient's recovery was uneventful and he was discharged on the 6th postoperative day.
authors.affiliation: Cardiac Surgery Unit-Polo Pontino, Heart and Great Vessels Department, University of Roma Sapienza, Via F, Faggiana 34, Latina-Italy. federico.bizzarri@uniroma1.it
authors.forename: Federico
authors.initials: F
authors.lastname: Bizzarri
authors.forename: Consalvo
authors.initials: C
authors.lastname: Mattia
authors.forename: Massimo
authors.initials: M
authors.lastname: Ricci
authors.forename: Flaminia
authors.initials: F
authors.lastname: Coluzzi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Petrozza
authors.forename: Giacomo
authors.initials: G
authors.lastname: Frati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pugliese
authors.forename: Luigi
authors.initials: L
authors.lastname: Muzzi
mesh_terms: D000208:Acute Disease; D006350:Heart Valve Prosthesis; D006801:Humans; D007238:Infarction / Q000150:complications*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000209:etiology* / Q000601:surgery; D010210:Papillary Muscles; D012421:Rupture / Q000209:etiology; D012770:Shock, Cardiogenic / Q000209:etiology*; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T