Abstract
The patient, a 65-year-old-male, had chest pain while sleeping, and visited our department the next morning. Systolic blood pressure was 90mmHg, and pansystolic murmurs in the left sternal boundary and moist rales in the lungs were detected by auscultation. ST elevation of II, III, and aVF was observed by electrocardiography, and ventricular septal rupture was found by echocardiography. The Qp/Qs was 2.5, and the left-to-right shunt rate was 62%. Complete occlusion of the right coronary artery was observed by coronary angiography. Intra-aortic balloon pumping was performed and the ventricular septal rupture was closed with a patch on the same day. Partial rupture of the posterior papillary muscle was found during surgery, and muscle bundles with tendinous cords were sutured with healthy papillary muscle. On the 10th day after operation, complete rupture of the posterior papillary muscle occurred below the site where the posterior papillary muscle had been sutured. On the 11th postoperative day, mitral valve plasty was performed, resulting in stable hemodynamics. The patient was discharged on the 39th day after operation. This is the second case reported in Japan of myocardial infarction accompanied by ventricular septal rupture and complete rupture of the posterior papillary muscle, and the first case successfully managed by emergent operation.
