The use of venoarterial ECMO as a successful strategy in acute severe mitral regurgitation secondary to papillary muscle rupture due to acute myocardial infarction: A case report and narrative review

Rationale: Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare but often life-threatening mechanical complication post-acute myocardial infarction (MI). The use of peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to mitral valve replacement surgery may improve outcome of such patients. Patient concerns: We reported the case of a 70-year old woman with past history who presented to the emergency department at People’s Hospital of Rizhao with “a 5-day history of chest distress.” She developed refractory cardiogenic shock, severe pulmonary edema and severe acidosis. Diagnoses: Restoration of spontaneous circulation following PCI, VA-ECMO, IABP, and early mitral valve replacement. Interventions: After performing percutaneous coronary intervention (PCI) supported by VA-ECMO and intra-aortic balloon pump (IABP), our group performed a early mitral valve replacement for this patient. Outcomes: This patient preliminarily made a good recovery after VA-ECMO and IABP discontinued. Lessons: This case demonstrated that VA ECMO combined with PCI, VA-ECMO, IABP and early mitral valve replacement can result in favorable outcomes, and might be viable emergency therapeutic options.