J Chest Surg.  2022 Jun;55(3):239-242. 10.5090/jcs.21.150.

A Hybrid Intervention for Post-infarction Papillary Muscle Rupture with Severe Mitral Regurgitation: A Case Report

• Nakamae K
• Oshitomi T
• Uesugi H

• KMID: 2530407
• DOI: http://doi.org/10.5090/jcs.21.150

Abstract

Papillary muscle rupture with severe acute mitral regurgitation is a rare complication of acute myocardial infarction (AMI) that causes pulmonary congestion and cardiogenic shock. Moreover, it has a poor prognosis. Surgical intervention, including revascularization, is indicated; however, surgical mortality remains high. We report the case of an 85-year-old woman with cardiogenic shock from severe acute mitral regurgitation, in whom a hybrid intervention, combining percutaneous coronary intervention with mitral valve replacement via minithoracotomy, was performed after post-infarction papillary muscle rupture. She was discharged in a favorable clinical condition. We describe a novel hybrid intervention for treating a rare complication of AMI, which could minimize surgical invasion in elderly patients, prevent disuse syndrome after the intervention, and improve prognosis. However, mitral valve surgery via minithoracotomy for emergency cases requires technical proficiency, as well as collaboration with other healthcare professionals, and the choice to perform this procedure requires careful consideration.

Keyword

Acute mitral regurgitation; Papillary muscle rupture; Mitral valve replacement; Minimally invasive cardiac surgery; Hybrid intervention; Case report