title: Ischemic rupture of the anterolateral papillary muscle.
abstract: We describe the case of a 59-year-old man who presented with chest pain and ST-segment elevation in the inferior leads, R>S in V1 and ST depression in the anterior leads due to proximal occlusion of the first obtuse marginal. Primary coronary angioplasty and stenting of this artery were performed. Twelve hours later the patient became hemodynamically unstable and severe mitral regurgitation due to rupture of one of the heads of the anterolateral papillary muscle was diagnosed. Emergency surgery was performed (papillary muscle head reimplantation, mitral annuloplasty with a rigid ring, tricuspid annuloplasty and coronary artery bypass grafting). On surgical inspection, it was observed that the detached muscle head had become trapped in the left ventricle by a secondary cord attached to the other head. This case is unusual in presenting two uncommon features of ischemic papillary muscle: rupture of the anterolateral muscle in myocardial infarction involving the inferoposterior walls, and the fact that the ruptured muscle head did not prolapse because it had become trapped in the left ventricle by secondary cord attachment.
authors: Department of Cardiology, Hospital de Braga, Braga, Portugal. cfvieira1982@hotmail.com
authors: Catarina
authors: C
authors: Vieira
authors: António
authors: A
authors: Gaspar
authors: Miguel
authors: M
authors: Alvares Pereira
authors: Nuno
authors: N
authors: Salomé
authors: Jorge
authors: J
authors: Almeida
authors: Mário Jorge
authors: MJ
authors: Amorim
mesh_terms: D006342:Heart Rupture, Post-Infarction; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications*; D017202:Myocardial Ischemia / Q000150:complications*; D010210:Papillary Muscles