Coma-Canella I, Gamallo C, Onsurbe P M, Jadraque L M
Coronary Care Unit, Hospital La Paz, Madrid, Spain.
Am Heart J. 1989 Dec;118(6):1188-92. doi: 10.1016/0002-8703(89)90008-2.
To investigate the consequences of acute papillary muscle necrosis of the left ventricle, 25 cases from a total of 133 autopsies of acute myocardial infarction were studied. Cardiac hypertrophy was found in 84%. The anterior papillary muscle was involved in four cases, the posterior in 13, and both muscles in eight. Left ventricular subendocardial infarction was found in 32% of cases. The size of left ventricular necrosis ranged from 11% to 75% of the left ventricular mass. Associated right ventricular infarction was observed in 68%. There were 19 cases of cardiogenic shock, four cases of pulmonary edema, and two cases of sudden death. We conclude that papillary muscle necrosis is usually associated with cardiac hypertrophy, posterior necrosis of both ventricles, and subendocardial infarction. Acute mitral regurgitation is probably an important contributing factor to clinical impairment and death, mostly in cases of small necrosis.
为研究急性左心室乳头肌坏死的后果，对133例急性心肌梗死尸检病例中的25例进行了研究。发现84%的病例存在心脏肥大。前乳头肌受累4例，后乳头肌受累13例，双侧乳头肌受累8例。32%的病例发现左心室心内膜下梗死。左心室坏死面积占左心室质量的11%至75%。观察到68%的病例伴有右心室梗死。有19例心源性休克、4例肺水肿和2例猝死。我们得出结论，乳头肌坏死通常与心脏肥大、双侧心室后壁坏死以及心内膜下梗死有关。急性二尖瓣反流可能是导致临床功能障碍和死亡的重要因素，在坏死面积较小的病例中尤为常见。
