Surgical Treatment of Papillary-Muscle Rupture Complicating Myocardial Infarction

Mitral-valve replacement was performed in five patients with ruptured papillary muscle secondary to myocardial infarction. In each case severe mitral regurgitation was suggested by the sudden appearance of a systolic murmur followed by progressive congestive heart failure. The diagnosis was confirmed by the presence of giant systolic waves in the pulmonary wedge tracing in four and of severe mitral regurgitation by left ventricular angiography in one. Open-heart surgery was performed at intervals of 14 days to 14 months after the acute infarct; four of the patients survive and are now doing well.