Papillary muscle rupture complicating acute myocardial infarction: Analysis of 17 patients

Rick A. Nishimura, Hartzell V Schaff, Clarence Shub, Bernard J. Gersh, William D. Edwards, Abdul J. Tajik

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from <24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.

Original languageEnglish (US)
Pages (from-to)373-377
Number of pages5
JournalThe American Journal of Cardiology
Volume51
Issue number3
DOIs
StatePublished - 1983

Fingerprint

Papillary Muscles
Rupture
Myocardial Infarction
Autopsy
Lung
Mitral Valve Insufficiency
Mitral Valve
Coronary Artery Bypass
Hypotension
Coronary Disease
Coronary Artery Disease
Transplants
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Papillary muscle rupture complicating acute myocardial infarction : Analysis of 17 patients. / Nishimura, Rick A.; Schaff, Hartzell V; Shub, Clarence; Gersh, Bernard J.; Edwards, William D.; Tajik, Abdul J.

In: The American Journal of Cardiology, Vol. 51, No. 3, 1983, p. 373-377.

Research output: Contribution to journalArticle

Nishimura, Rick A. ; Schaff, Hartzell V ; Shub, Clarence ; Gersh, Bernard J. ; Edwards, William D. ; Tajik, Abdul J. / Papillary muscle rupture complicating acute myocardial infarction : Analysis of 17 patients. In: The American Journal of Cardiology. 1983 ; Vol. 51, No. 3. pp. 373-377.
@article{9b2be1997ea24794bdd54da2532ec82c,
title = "Papillary muscle rupture complicating acute myocardial infarction: Analysis of 17 patients",
abstract = "The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from <24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.",
author = "Nishimura, {Rick A.} and Schaff, {Hartzell V} and Clarence Shub and Gersh, {Bernard J.} and Edwards, {William D.} and Tajik, {Abdul J.}",
year = "1983",
doi = "10.1016/S0002-9149(83)80067-8",
language = "English (US)",
volume = "51",
pages = "373--377",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Papillary muscle rupture complicating acute myocardial infarction

T2 - Analysis of 17 patients

AU - Nishimura, Rick A.

AU - Schaff, Hartzell V

AU - Shub, Clarence

AU - Gersh, Bernard J.

AU - Edwards, William D.

AU - Tajik, Abdul J.

PY - 1983

Y1 - 1983

N2 - The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from <24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.

AB - The records of 17 patients (10 men and 7 women) with the diagnosis of acute papillary muscle rupture secondary to acute myocardial infarction (AMI) were reviewed to determine the clinical course and pathologic features of this entity. Eight patients underwent operation after papillary muscle rupture had been diagnosed, and 9 had the diagnosis confirmed at autopsy without a prior surgical procedure. The ages were 44 to 80 years (mean 64). The site of AMI was inferolateral in 15 and anterior in 2. The recorded onset of mitral regurgitation ranged from <24 hours to 28 days after AMI (mean 6 days). Of the 11 patients presenting with pulmonary congestion alone, 6 remained stable and had subsequent mitral valve replacement and coronary artery bypass graft operation; however, 5 patients' condition initially stabilized with medical therapy and then suddenly deteriorated after a variable period (1 to 60 days), followed by death. Of the 6 patients who presented with systemic hypotension and pulmonary congestion, 4 were treated medically and died; 1 of the 2 who had surgical treatment survived. The extent of the AMI at autopsy was small and was limited to the subendocardium in half of the patients. Significant coronary artery disease was limited to a single vessel in 7 of 14 patients. The unpredictable and rapid clinical deterioration and the limited extent of coronary atherosclerotic disease and infarct size suggest that early surgical repair should be undertaken in patients with papillary muscle rupture after AMI.

UR - http://www.scopus.com/inward/record.url?scp=0020693370&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0020693370&partnerID=8YFLogxK

U2 - 10.1016/S0002-9149(83)80067-8

DO - 10.1016/S0002-9149(83)80067-8

M3 - Article

C2 - 6823851

AN - SCOPUS:0020693370

VL - 51

SP - 373

EP - 377

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 3

ER -