Ishii Koji, Myojin K, Ishibashi Y, Kawasaki M, Matsukawa M, Kunishige H, Koide T, Takenaka T
Department of Cardiovascular Surgery, Hokkaido Cancer Center, Sapporo, Japan.
Kyobu Geka. 2005 Apr;58(4):295-9.
Papillary muscle rupture is a rare but severe complication of acute myocardial infarction. Two cases successfully underwent mitral valve replacement and concomitant coronary artery bypass grafting (CABG) for acute myocardial infarction with the anterior papillary muscle rupture in cardiogenic shock. Each of them needed preoperative massive inotropic infusion, respiratory support and intraaortic balloon pumping assist. The first case was a 76-year-old female. Double vessel disease (seg 7 : 90%, seg 11 : 100%) was revealed by coronary angiography and rupture of the papillary muscle was confirmed by transesophageal echocardiography. The second case was a 69-year-old female. Double vessel disease (seg 2 : 90%, seg 11 : 100%) was revealed and severe mitral regurgitation due to prolapse of the anterior leaflet was confirmed by transthoracic echocardiography. To assess the diagnosis of postinfarction papillary muscle rupture, transthoracic and/or transesophageal echocardiography is mandatory. Coronary angiography is also desirable because concomitant myocardial revascularization may improve the prognosis.
乳头肌断裂是急性心肌梗死罕见但严重的并发症。两例因急性心肌梗死合并前乳头肌断裂导致心源性休克的患者成功接受了二尖瓣置换术及同期冠状动脉旁路移植术（CABG）。他们术前均需要大量应用血管活性药物、呼吸支持及主动脉内球囊反搏辅助。第一例为76岁女性。冠状动脉造影显示双支血管病变（第7段：90%，第11段：100%），经食管超声心动图证实乳头肌断裂。第二例为69岁女性。冠状动脉造影显示双支血管病变（第2段：90%，第11段：100%），经胸超声心动图证实因前叶脱垂导致严重二尖瓣反流。为评估心肌梗死后乳头肌断裂的诊断，经胸和/或经食管超声心动图检查必不可少。冠状动脉造影也有必要进行，因为同期心肌血运重建可能改善预后。
