Successful Mitral Valve Repair for Papillary Muscle Rupture Caused by Coronary Spasm Induced by Myocardial Infarction

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Papillary muscle rupture caused by coronary spasm (MINOCA) (n=1). Intervention: Mitral valve repair and coronary artery bypass grafting. Primary outcome: Survival and hospital discharge.

Yohnosuke Wada; Homare Okamura; Yuichiro Kitada; Tomonari Fujimori; Hideo Adachi

doi:10.4326/jjcvs.51.25

January 15, 2022Japanese Journal of Cardiovascular SurgeryOpen Access

Successful Mitral Valve Repair for Papillary Muscle Rupture Caused by Coronary Spasm Induced by Myocardial Infarction

View Full Paper

Ask AI

Bookmark

Share

Why the study?

Papillary muscle rupture leading to acute mitral regurgitation is a rare complication following acute myocardial infarction, and reports involving coronary spasm are extremely rare.

Key Points

To report a rare presentation of acute mitral regurgitation resulting from coronary spasm-induced papillary muscle rupture managed successfully with valve repair and revascularization.
Emergency coronary angiography was performed on a 64-year-old female presenting with acute coronary syndrome and acute mitral regurgitation secondary to papillary muscle rupture.
Surgical intervention comprised mitral valve repair and two-vessel coronary artery bypass grafting using saphenous vein grafts to the right coronary artery and the posterolateral branch.
Coronary angiography demonstrated right coronary artery spasm alongside complex disease in the left circumflex artery, including aneurysm formation with 90% stenosis in segment 11 and 50% stenosis in segment 13.
The patient had an uncomplicated postoperative recovery and was safely discharged home in ambulatory condition on postoperative day 13.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 64-year-old woman with acute mitral valve regurgitation due to posteromedial papillary muscle rupture caused by coronary spasm (MINOCA).

I

Intervention

Mitral valve repair (physio ring II 28 mm, artificial chordae) and coronary artery bypass grafting (CABG x 2: SVG-RCA #3, SVG-PL).

O

Outcome

Successful surgery and hospital discharge

Mitral valve repair can be successfully performed for papillary muscle rupture caused by coronary spasm (MINOCA).

Limitations

Single case report
Coronary spasm provocation test was not performed due to safety concerns

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Coronary spasm warrants consideration in post-MI papillary muscle rupture; leaves open its causal role in MINOCA-related complications.

Abstract

［目的］急性心筋梗塞後の稀な合併症の1つとして乳頭筋断裂による急性僧帽弁閉鎖不全症があるが，冠動脈攣縮が関与したと考えられる乳頭筋断裂の報告はきわめて稀である．［症例］特に既往歴のない64歳女性．数カ月前の朝方の胸部違和感と1週間前からの呼吸苦を主訴に来院し，急性冠症候群と乳頭筋断裂の診断で緊急冠動脈造影検査を施行した．術前冠動脈造影検査時に右冠動脈の攣縮が疑わしい所見を認め，その他左回旋枝#11に冠動脈瘤形成と90%狭窄，#13に50%狭窄を認めた．手術は，僧帽弁形成術と冠動脈バイパス術２枝（大伏在静脈-右冠動脈#3，大伏在静脈-後側壁枝）を施行した．術後経過良好で，第13病日に独歩退院した．［結語］近年冠動脈狭窄が50%未満の心筋梗塞（Myocardial Infarction with Non-Obstructive Coronary Arteries : MINOCA）という概念が報告され，冠動脈攣縮も原因の1つと考えられ，本症例もMINOCAであった可能性が示唆される．

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Wada et al. (2022) conducted a case report in Papillary muscle rupture caused by coronary spasm (MINOCA) (n=1). Mitral valve repair and coronary artery bypass grafting was evaluated on Survival and hospital discharge.

synapsesocial.com/papers/6a9a9fbd45a45142459c739b https://doi.org/10.4326/jjcvs.51.25

View Full Paper

Ask AI

Bookmark

Share

Successful Mitral Valve Repair for Papillary Muscle Rupture Caused by Coronary Spasm Induced by Myocardial Infarction

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Successful Mitral Valve Repair for Papillary Muscle Rupture Caused by Coronary Spasm Induced by Myocardial Infarction

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading