Department of General Surgery, Houston Methodist Hospital, Houston, TX, USA.
DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Smith Tower Suite 1401, Houston, TX, 77030, USA.
J Cardiothorac Surg. 2022 Jul 8;17(1):173. doi: 10.1186/s13019-022-01854-2.
Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines.
This case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge.
In patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.
感染性心内膜炎导致的乳头肌破裂是一种罕见的情况，目前文献中并未描述这种情况下的适当处理方法。本病例旨在使用现有指南阐明此类患者的治疗策略。
本病例为 58 岁男性，因乳头肌破裂导致急性心力衰竭。他接受了二尖瓣整块切除术和生物瓣置换术。随后的标本病理学检查显示，乳头肌因感染性心内膜炎而坏死。患者进一步接受了抗生素治疗。术后恢复良好，出院后情况也一直良好。
对于因感染性心内膜炎导致乳头肌破裂的患者，临床症状应指导治疗策略。尽管病因不同，但对于因乳头肌破裂导致急性心力衰竭的患者，早期二尖瓣手术仍然是治疗的首选方法。对于这一类患者，包括植入了人工瓣膜的患者，基于培养的延长抗生素治疗至关重要。
