The Clinical Spectrum of Papillary-Muscle Disease

ALTHOUGH the role of the papillary muscles in mitral-valve closure has been appreciated for over a century1 , 2 the clinical importance of disease of these structures has emerged only within the past decade. It is now recognized that there is a broad clinical spectrum of papillary-muscle malfunction, ranging from a transient murmur in the asymptomatic patient with ischemic papillary-muscle dysfunction3 , 4 to florid mitral regurgitation and acute, fulminant pulmonary edema in the patient with papillary-muscle rupture.5 6 7 Ischemic malfunction of the papillary muscles was thought to cause mitral regurgitation as early as 1935,8 and this mechanism was further emphasized by Burch and Phillips . . .