Alam Loba, Lasam Glenmore, Fishberg Robert, Powell David
Internal Medicine, Overlook Medical Center, Summit , USA.
Cardiology, Mt. Sinai Morningside, Summit, USA.
Cureus. 2021 Mar 19;13(3):e13996. doi: 10.7759/cureus.13996.
Mitral valve rupture secondary to ischemic papillary muscle necrosis is rare in the contemporary era due to improved revascularization techniques. However, when it does occur, prompt diagnosis and urgent surgical intervention can be lifesaving. A 69-year-old male with morbid obesity, hypothyroidism, and a family history of coronary artery disease presented to the hospital with chest pain and dyspnea that began five hours prior. He had an acute infero-postero-lateral myocardial infarction due to total occlusion of the left circumflex artery that was revascularized with the deployment of a drug-eluting stent. Two days after the myocardial infarction, the patient had an episode of ventricular tachycardia. He subsequently went into respiratory distress from flash pulmonary edema and developed cardiogenic shock due to acute mitral valve rupture. The patient underwent surgical mitral valve replacement, extracorporeal membranous oxygenation (ECMO), and hemodialysis. His course was complicated by an acute lower gastrointestinal bleed that progressed into multiorgan failure and eventually his demise. This case highlights the need to include papillary muscle rupture high on the differential when evaluating a hemodynamically unstable patient in the setting of an acute myocardial infarction (MI). Rapid diagnosis by urgent bedside echocardiogram and surgical intervention is crucial.
由于血管重建技术的改进，在当代，缺血性乳头肌坏死继发二尖瓣破裂很少见。然而，当这种情况确实发生时，及时诊断和紧急手术干预可挽救生命。一名69岁男性，患有病态肥胖、甲状腺功能减退症且有冠状动脉疾病家族史，因5小时前开始出现胸痛和呼吸困难入院。他因左旋支动脉完全闭塞发生急性下后壁心肌梗死，通过植入药物洗脱支架实现了血管重建。心肌梗死后两天，患者发生室性心动过速。随后，他因急性肺水肿出现呼吸窘迫，并因急性二尖瓣破裂发展为心源性休克。患者接受了二尖瓣置换手术、体外膜肺氧合（ECMO）和血液透析。他的病程因急性下消化道出血而复杂化，进而发展为多器官功能衰竭，最终死亡。该病例强调，在评估急性心肌梗死（MI）背景下血流动力学不稳定的患者时，需将乳头肌破裂列为鉴别诊断的重要考虑因素。通过紧急床边超声心动图进行快速诊断和手术干预至关重要。
