Rayamajhi Karuna, Parul Fnu, Kumar Rohan, Khairy Mahmoud, Kehdi Michael J
Internal Medicine, University of Michigan/Sparrow Hospital, Lansing, USA.
Medicine, Michigan State University, Lansing, USA.
Cureus. 2025 May 17;17(5):e84304. doi: 10.7759/cureus.84304. eCollection 2025 May.
Spontaneous papillary muscle rupture is a rare and life-threatening event. We present the case of a 70-year-old male who presented with shortness of breath and cough, with imaging findings consistent with flash bilateral pulmonary edema. Due to progressive respiratory failure and cardiogenic shock, he required emergent intubation and initiation of inotropic and vasopressor support. Transthoracic echocardiogram was concerning for a flail anterior mitral leaflet and showed normal left ventricular systolic function. As there was concern for acute mitral regurgitation, an emergent transesophageal echocardiography was performed and showed severe mitral regurgitation with a flail anterior mitral leaflet secondary to a ruptured anterolateral papillary muscle. The patient underwent emergent intra-aortic balloon pump placement and coronary angiography, which revealed 80% stenosis of the proximal left anterior descending artery. Subsequently, the patient underwent mitral valve replacement and single-vessel coronary artery bypass grafting (CABG) with the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Post-surgery, a repeat transthoracic echocardiography (TTE) revealed severe biventricular systolic dysfunction. His hospital course was further complicated by the development of a large left atrial thrombus, necessitating removal of VA-ECMO and subsequently placement of an Impella (Abiomed, Danvers, MA) and right ventricular assist device (RVAD). After a prolonged hospital stay, the patient's condition stabilized, and he was discharged home with follow-up echocardiography demonstrating a recovered ejection fraction.
自发性乳头肌破裂是一种罕见且危及生命的事件。我们报告一例70岁男性患者，其表现为呼吸急促和咳嗽，影像学检查结果符合急性双侧肺水肿。由于进行性呼吸衰竭和心源性休克，他需要紧急插管并开始使用正性肌力药物和血管升压药支持治疗。经胸超声心动图显示二尖瓣前叶连枷样运动，左心室收缩功能正常。由于怀疑存在急性二尖瓣反流，遂紧急进行经食管超声心动图检查，结果显示严重二尖瓣反流，二尖瓣前叶连枷样运动，系前外侧乳头肌破裂所致。患者接受了紧急主动脉内球囊泵置入术和冠状动脉造影，结果显示左前降支近端狭窄80%。随后，患者接受了二尖瓣置换术和单支冠状动脉旁路移植术（CABG），并开始使用静脉-动脉体外膜肺氧合（VA-ECMO）。术后，重复经胸超声心动图（TTE）显示严重的双心室收缩功能障碍。患者的住院病程因出现巨大左心房血栓而进一步复杂化，因此必须撤掉VA-ECMO，随后置入Impella（Abiomed，丹弗斯，马萨诸塞州）和右心室辅助装置（RVAD）。经过长时间住院，患者病情稳定，出院时超声心动图随访显示射血分数恢复正常。
