Abstract
Papillary muscle rupture is a rare but devastating complication following acute myocardial infarction (AMI). It should be treated with early stabilization of the circulation and early surgery. Here, we report two cases of papillary muscle rupture following AMI with different outcomes. In patient 1, a 78-year-old man was diagnosed with AMI. He presented with hypotension and hypoventilation. Transthoracic echocardiography (TTE) showed moderate mitral regurgitation (MR). Emergency coronary angiography (CAG) demonstrated 90% stenosis of the right coronary artery (RCA) and 100% obstruction of the left circumflex artery. Coronary revascularization was performed before the surgical procedure. The patient died 49 days after cardiac surgery. In patient 2, a 65-year-old man was transferred to our hospital with dyspnea and shock. TTE showed severe MR. CAG showed a dominant RCA without stenosis, left ascending artery with 90% stenosis, and left circumflex artery with 100% obstruction. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was established, and emergent surgery was performed without coronary revascularization. The patient was discharged 12 weeks after surgery. Thus, early introduction of mechanical circulatory support and early surgery could be significant in achieving a better outcome.
