Kunioka Shingo, Kitahara Hiroto, Kanda Hirotsugu, Takeda Tomohiro, Yoshida Yuri, Ishikawa Natsuya, Kamiya Hiroyuki
Department of Cardiac Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan.
Section of Cardiac and Thoracic Surgery, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, E500, MC5040, Chicago, IL, 60637, USA.
J Artif Organs. 2017 Sep;20(3):263-265. doi: 10.1007/s10047-017-0951-z. Epub 2017 Feb 26.
We report a rare case of papillary muscle rupture due to myocardial infarction during left ventricular assist device support. A 69-year-old woman with cardiogenic shock due to acute myocardial infarction requiring venoarterial extracorporeal membrane oxygenation support was transferred for further surgical intervention. Six days after the event, extracorporeal membrane oxygenation was decannulated, and an extracorporeal left ventricular assist device was implanted. On postoperative day 11, she suffered from sudden onset hypoxia due to pulmonary edema. Transesophageal echocardiography showed new onset severe mitral regurgitation. No further surgical intervention was performed according to the family's wishes, and she passed away on the 22nd postoperative day. Autopsy findings revealed papillary muscle rupture. Although the left ventricle is unloaded by the left ventricular assist device, papillary muscle rupture should be recognized as a possible complication after myocardial infarction.
我们报告了一例在左心室辅助装置支持期间因心肌梗死导致乳头肌破裂的罕见病例。一名69岁女性因急性心肌梗死导致心源性休克，需要静脉-动脉体外膜肺氧合支持，被转至我院进行进一步手术干预。事件发生6天后，拔除体外膜肺氧合插管，并植入体外左心室辅助装置。术后第11天，她因肺水肿突然出现缺氧。经食管超声心动图显示新发严重二尖瓣反流。根据家属意愿未进行进一步手术干预，她于术后第22天去世。尸检结果显示乳头肌破裂。尽管左心室辅助装置减轻了左心室负荷，但乳头肌破裂仍应被视为心肌梗死后可能出现的并发症。
