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Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction

Aim: 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 HMz multiplane phased array transducer. We are reporting about two patients (a 45 male and 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. Conclusion: Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE.

mitral valve replacement ; coronary artery bypass grafting

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