Hashino R, Ohkubo T, Kaneko K, Goko C, Satoh M
Department of Cardiovascular Surgery, Nakadori General Hospital, Akita, Japan.
Kyobu Geka. 1993 Jun;46(6):536-9.
Cardiogenic shock caused by papillary muscle rupture in acute myocardial infarction is potentially reversible by surgical treatment. A case of posterior myocardial infarction in a 79-year-old woman is reported. She was admitted to the hospital in cardiogenic shock. She had been suffered from chest pain for three days before admission. On physical examination diffuse rales and a grade 4/6 holosystolic apical murmur were present. The diagnosis of an acute posterior myocardial infarction was based on the electrocardiographic findings and serum creatine kinase level. Coronary angiography visualized subtotal occlusion of the left circumflex coronary artery. Transesophageal echocardiography demonstrated severe mitral regurgitation and the ruptured anterior papillary muscle connected to normal chordae tendineae and posterior mitral leaflet. In systole, the head of the ruptured papillary muscle moved like a whip in the left atrium. At operation, the ruptured papillary muscle was confirmed. Mitral valve replacement with a 27 mm St. Jude Medical prosthesis and coronary artery bypass grafting to the left circumflex coronary artery was performed. Postoperatively she was weaned intraaortic balloon pumping after 4 days and recovered uneventfully.
急性心肌梗死所致乳头肌断裂引起的心源性休克，通过手术治疗有可能逆转。本文报道了一例79岁女性的后壁心肌梗死病例。她因心源性休克入院。入院前她胸痛已持续三天。体格检查发现双肺满布湿啰音，心尖部有4/6级全收缩期杂音。急性后壁心肌梗死的诊断基于心电图表现和血清肌酸激酶水平。冠状动脉造影显示左旋支冠状动脉次全闭塞。经食管超声心动图显示严重二尖瓣反流，破裂的前乳头肌与正常腱索及二尖瓣后叶相连。收缩期，破裂乳头肌的头部在左心房内像鞭子一样摆动。手术中证实了乳头肌断裂。使用27毫米圣犹达医疗人工瓣膜进行二尖瓣置换，并对左旋支冠状动脉进行冠状动脉搭桥术。术后4天她撤离主动脉内球囊反搏，恢复顺利。
