Cannata Francesco, Tamborini Gloria, Zanobini Marco, Marana Ivana, Muratori Manuela, De Marco Federico, Pontone Gianluca, Pepi Mauro
Centro Cardiologico Monzino IRCCS, Milan, Italy.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Eur Heart J Case Rep. 2024 Sep 25;8(10):ytae533. doi: 10.1093/ehjcr/ytae533. eCollection 2024 Oct.
Acute mitral regurgitation due to papillary muscle rupture is a severe complication of acute myocardial infarction. Transcatheter edge-to-edge repair is emerging as an effective alternative to surgical treatment, with encouraging outcomes. Leaflet adverse events are rare and are associated with relapse of significant mitral regurgitation.
A 54-year-old man arrived at our hospital with a late presentation of ST-elevation myocardial infarction. During primary percutaneous coronary intervention of the circumflex coronary artery, a partial papillary muscle rupture occurred with acute severe mitral regurgitation and cardiogenic shock. Due to the severe haemodynamic instability, the patient underwent an emergent transcatheter edge-to-edge repair with MitraClip device during Impella support with mitral regurgitation resolution and haemodynamic stabilization. At 2-month follow-up, an interclip leaflet tear occurred with relapse of severe mitral regurgitation, requiring a mitral valve replacement surgery.
Acute mitral regurgitation due to papillary muscle rupture is a serious complication of acute myocardial infarction. Management is based on haemodynamic stabilization and surgery. The transcatheter edge-to-edge repair is emerging as a therapeutic alternative in high-risk cases. Leaflet adverse events rarely occur during the transcatheter edge-to-edge repair procedure or before patient discharge. Our case is the first to report a late leaflet adverse event, occurring two months after the procedure and, interestingly, after an acute myocardial infarction conditioning an ischaemic mitral regurgitation. This event may be the result of the progressive adverse remodelling of left ventricular inferolateral akinetic wall, with consequent increase of tethering forces on the posterior leaflet, tensioned in the opposite direction by the clip.
乳头肌破裂导致的急性二尖瓣反流是急性心肌梗死的严重并发症。经导管缘对缘修复正成为手术治疗的一种有效替代方法，效果令人鼓舞。瓣叶不良事件罕见，且与严重二尖瓣反流复发相关。
一名54岁男性因ST段抬高型心肌梗死延迟就诊入院。在对回旋支冠状动脉进行初次经皮冠状动脉介入治疗期间，发生了部分乳头肌破裂，伴有急性严重二尖瓣反流和心源性休克。由于严重的血流动力学不稳定，患者在Impella支持下使用MitraClip装置进行了紧急经导管缘对缘修复，二尖瓣反流得以解决，血流动力学稳定。在2个月的随访中，夹子间瓣叶撕裂，严重二尖瓣反流复发，需要进行二尖瓣置换手术。
乳头肌破裂导致的急性二尖瓣反流是急性心肌梗死的严重并发症。治疗基于血流动力学稳定和手术。经导管缘对缘修复正成为高危病例的一种治疗选择。在经导管缘对缘修复过程中或患者出院前很少发生瓣叶不良事件。我们的病例是首次报告术后两个月出现的晚期瓣叶不良事件，有趣的是，这一事件发生在急性心肌梗死后，导致缺血性二尖瓣反流。这一事件可能是左心室下外侧运动减弱壁进行性不良重塑的结果，从而增加了对后叶的牵拉力量，夹子则在相反方向对其产生张力。
