Rupture of the papillary muscles

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Rupture of the papillary muscles

Internal rupture of the heart is a violation of the integrity of the intracavitary elements of the heart wall (interventricular septum, papillary muscles) due to their necrosis and myomalacia. Rupture of the papillary muscles is a type of internal rupture of the heart; complete or partial rupture of the papillary muscles of the left ventricle leads to prolapse of the mitral valve leaflets into the cavity of the left atrium, acute mitral valve insufficiency. The reasons

    • THEM
    • Heart injury.

Pathomorphology

    • 80% of cases are an isolated rupture of the posterior papillary muscle of the left ventricle (usually with inferior MI), which has a blood supply source from the posterior descending branch of the right coronary artery. Rupture of the anterior papillary muscle, which receives blood supply from the basin of the anterior and circumflex arteries, occurs much less frequently.
    • With MI, the development of severe mitral valve insufficiency is due to severe dysfunction of the papillary muscle due to its ischemic damage, thinning and stretching. Mitral valve prolapse without rupture of the papillary muscle is found in 50% of patients during surgical correction 2 months after MI.

Clinical picture

    • Sudden onset of a systolic murmur with an epicenter over the apex of the heart, sometimes systolic trembling over the region of the heart
    • Acute development of mitral valve insufficiency is a progressive deterioration of the patient’s condition with a drop in blood pressure, a picture of increasing left ventricular failure, pulmonary edema and / or cardiogenic shock.

Special Studies

    • 2D echocardiography
    • Invasive methods
    • Pulmonary wedge pressure measurement

arteries using a Swan-Ganz catheter

    • Ventriculography – allows you to exclude or detect shunt from left to right in case of rupture of the interventricular septum.

Treatment:

Conservative therapy – see Acute left ventricular failure. Surgical treatment – mitral valve replacement with a synthetic or biological prosthesis or wedge resection of the leaflet with annuloplasty in case of damage to the posterior papillary muscle. In the early postinfarction period, postoperative mortality reaches 50%.

Forecast

    • Sudden onset mitral regurgitation due to rupture of the papillary muscle is the root cause of death in 0.5% of patients with MI in periods from the first hours to 14 days
    • With a complete rupture of the papillary muscle, death begins within a few hours; without surgical treatment, only 25% of patients live more than 24 hours. Tearing of the papillary muscle or rupture of one of its several heads leads to less pronounced mitral regurgitation. In this case, within 70% of the sick people live more than a day, in 50% of them the life expectancy exceeds 30 days.

See also Mitral valve insufficiency, Cardiac insufficiency, Acute left ventricular failure ICD

    • 123.5 Rupture of the papillary muscle as a current complication of acute myocardial infarction
    • 151.2 Rupture of papillary muscle, not elsewhere classified