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J Chest Surg

Published online March 16, 2022

Copyright © Journal of Chest Surgery.

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

Kosuke Nakamae , M.D., Takashi Oshitomi , M.D., Hideyuki Uesugi , M.D.

Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan

Correspondence to:Kosuke Nakamae
Tel 81-96-351-8000
Fax 81-96-326-3045
E-mail kn_beat_maxplus@yahoo.co.jp
ORCID
https://orcid.org/0000-0003-3848-0153

Received: December 15, 2021; Revised: January 25, 2022; Accepted: January 31, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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

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J Chest Surg

Published online March 16, 2022

Copyright © Journal of Chest Surgery.

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

Kosuke Nakamae , M.D., Takashi Oshitomi , M.D., Hideyuki Uesugi , M.D.

Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan

Correspondence to:Kosuke Nakamae
Tel 81-96-351-8000
Fax 81-96-326-3045
E-mail kn_beat_maxplus@yahoo.co.jp
ORCID
https://orcid.org/0000-0003-3848-0153

Received: December 15, 2021; Revised: January 25, 2022; Accepted: January 31, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

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

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