Minakata K, Konishi Y, Matsumoto M, Miwa S, Yuasa S
Department of Cardiovascular Surgery, Japanese Red-Cross Society Wakayama Medical Center, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Apr;45(4):639-44.
Mitral regurgitation caused by papillary muscle rupture after acute myocardial infarction has poor prognosis, and it is the usual course for such cases in cardiogenic shock to be performed early mitral valve replacement. However, we recently experienced a case of successful scheduled mitral valve replacement for mitral regurgitation caused by rupture of the posterior papillary muscle after acute inferior myocardial infarction. The patient was a 63-year-old woman who admitted to a hospital with back pain and dyspnea and was diagnosed as pulmonary edema due to mitral regurgitation after acute myocardial infarction. She was treated with dopamine and diuretic agents effectively, but not weaned from these drugs. Then, she was transferred to our hospital. At the admission, she was in the NYHA class II due to mitral regurgitation and inferior myocardial infarction with papillary muscle rupture revealed by transesophageal echocardiography. Cardiac catheterization demonstrated total occlusion of the proximal right coronary artery (segment #2) and mitral regurgitation in Sellers III. The patient underwent a successful scheduled mitral valve replacement with SJM 27M concomitant with coronary artery bypass grafting 47 days after the onset of acute mitral regurgitation. There are few reports that successful surgical treatment for papillary muscle rupture was done more than 4 weeks after the onset of mitral regurgitation in Japan.
急性心肌梗死后乳头肌破裂所致二尖瓣反流预后较差，对于发生心源性休克的此类病例，早期行二尖瓣置换术是常规治疗方法。然而，我们最近遇到一例成功进行择期二尖瓣置换术的病例，该患者为急性下壁心肌梗死后后乳头肌破裂所致二尖瓣反流。患者为一名63岁女性，因背痛和呼吸困难入院，被诊断为急性心肌梗死后二尖瓣反流所致肺水肿。她接受多巴胺和利尿剂治疗有效，但未能停用这些药物。随后，她被转至我院。入院时，由于二尖瓣反流，她处于纽约心脏协会（NYHA）心功能II级，经食管超声心动图显示存在下壁心肌梗死伴乳头肌破裂。心脏导管检查显示右冠状动脉近端（第2节段）完全闭塞，二尖瓣反流为Sellers III级。急性二尖瓣反流发病47天后，患者成功进行了择期二尖瓣置换术，置换的是SJM 27M人工瓣膜，并同时进行了冠状动脉旁路移植术。在日本，很少有关于二尖瓣反流发病4周后成功进行乳头肌破裂手术治疗的报道。
