Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction.
OBJECTIVE
To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle.


METHODS
Transthoracic (TTE) and transesophageal echocardiography (TEE) was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA) with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male) with complete ruptures of papillary muscle following acute myocardial infarction (AMI).


RESULTS
Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case.


CONCLUSIONS
Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE.
Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb, University of Applied Health Studies; Zagreb, School of Medicine, University J. J. Strossmayer, Osijek; Croatia.
Josip
J
Vincelj
Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb; Croatia.
Stanko
S
Biočić
Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb; Croatia.
Mario
M
Udovičić
Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb; Croatia.
Mario
M
Sičaja
Institute of Cardiovascular Diseases, Dubrava University Hospital, Zagreb; Croatia.
Sandra
S
Jakšić Jurinjak
D004452:Echocardiography; D006342:Heart Rupture, Post-Infarction / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010210:Papillary Muscles / Q000473:pathology
bypass grafting; bypass grafting.; coronary artery; mitral valve; replacement