A case of papillary muscle rupture diagnosed by transesophageal echocardiography

Abstract

We report a case of papillary muscle rupture that occurred after acute myocardial infarction. A 56 year old man was transferred to our hospital for acute chest pain. Immediate cardiac catheterization found a total occlusion in segment 2 of the right coronary artery. The patient experienced re-infarction on the third hospital day and developed progressively severe heart failure. Transthoracic echocardiography did not show any signs of papillary muscle rupture. Transesophageal echocardiography, however, did find ruptured papillary muscle in the left atrial and ventricular cavities. The patient underwent emergency mitral valve replacement using a prosthetic valve (SJM^(R)). Intraoperative findings confirmed total rupture of the posterior papillary muscle. Unfortunately, the patient died of heart failure 3 hours postoperatively. Transesophageal echocardiography was useful for diagnosis of ruptured papillary muscle in acute myocardial infarction.