Spontaneous Papillary Muscle Rupture Coexisting with Chronic Mitral Regurgitation – A Case Report

Given the low prevalence of coronary artery disease in the young, spontaneous papillary muscle rupture is an uncommon cause of severe mitral regurgitation and emergency admission in this age group. Spontaneous papillary muscle rupture is usually associated with features of acute mitral regurgitation. We highlight an incidental finding of a ruptured papillary muscle in a young adult with features of chronic mitral regurgitation. A 20-year-old male presented with a history of worsening symptoms of heart failure. Examination showed features of congestion, such as bilateral pedal oedema and tender hepatomegaly. The precordial examination revealed a displaced apex beat, gallop rhythm, and an apical pansystolic murmur. Transthoracic echocardiography showed thickened mitral valve leaflets, diastolic doming of the anterior mitral valve, ruptured papillary muscle with anterior mitral valve prolapse, restrictive mitral inflow pattern, severe mitral regurgitation, mild tricuspid regurgitation, and dilated cardiac chambers. At surgery, dilated cardiac chambers, avulsed anterolateral papillary muscle, and a prolapsed anterior mitral valve leaflet were seen. He had mitral valve replacement with a 31/33 ON-X mechanical mitral valve and left atrial ligation. He has since been on follow-up care. This case highlights that in rare cases, rheumatic heart disease can present with spontaneous papillary muscle rupture on a background chronic mitral regurgitation.