Papillary Muscle Rupture During Percutaneous Transvenous Mitral Commissurotomy: An Uncommon Scenario Exempt From Emergency Surgical Conversion

Papillary muscle rupture is a rare but serious complication during percutaneous transvenous mitral commissurotomy (PTMC). In many cases, it leads to acute significant mitral regurgitation (MR), requiring urgent surgical repair. We performed PTMC for a 49‐year‐old woman with symptomatic moderate rheumatic mitral stenosis. Initial balloon inflation resulted in papillary muscle rupture; however, it did not induce leaflet prolapse and worsening of MR. Finally, we succeeded in achieving a mean pressure gradient of less than 5 mmHg without worsening of MR through several balloon inflations. We experienced a rare case where papillary muscle rupture occurred during PTMC, but there was no development of acute significant MR, and salvage surgery was not required.