title: Triple cardiac rupture.
abstract: Left ventricular free wall rupture and acute ischaemic mitral regurgitation are nowadays rare, but still potentially lethal mechanical complications after acute myocardial infarction. We report a case of a sequential left ventricular free wall rupture, anterolateral papillary muscle disruption, secondary severe mitral regurgitation and subsequent posteromedial papillary muscle head rupture in a single patient during the same ischaemic episode after myocardial infarction, and their related successful surgical procedures and management until discharge. Prompt bedside diagnosis and emergent consecutive surgical procedures, as well as temporary left ventricular assistance, were crucial in the survival of this patient.
authors.affiliation: Department of Cardiac Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain avazsan@gmail.com.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Vazquez
authors.affiliation: Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Osa
authors.affiliation: Anesthesiology and Reanimation, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Vicente
authors.affiliation: Department of Cardiac Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Montero
mesh_terms: D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000209:etiology; D002315:Cardiopulmonary Bypass; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D006342:Heart Rupture, Post-Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D010210:Papillary Muscles / Q000503:physiopathology / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Acute mitral regurgitation; Free wall rupture; Mechanical complications; Myocardial infarction