Key result
3D TEE outperforms 2D imaging for identifying partial papillary muscle rupture and prolapsing scallops.
Why the study?
Accurate identification of partial posteromedial papillary muscle rupture in myocardial infarction patients is challenging with conventional imaging.
Case Report (n=1)
3D TEE may clarify post-MI papillary muscle rupture when 2D imaging is inconclusive; hypothesis-generating and requires prospective validation before wider adoption.
A 60-year-old hypertensive male with non-ST segment elevation myocardial infarction had a hyperdynamic LV with mild posterior leaflet mitral valve prolapse without significant regurgitation on transthoracic echocardiogram. Two-dimensional (2D) TEE showed severe mitral regurgitation with prolapse of P2 and P3 scallops. Posteromedial papillary muscle rupture was suspected. Three-dimensional (3D) TEE demonstrated severely prolapsing P2 and P3 valve scallops with a clear view of the partially ruptured posteromedial papillary muscle. Patient underwent emergency coronary bypass and mitral valve replacement. Surgical pathology of papillary muscle confirmed coagulative necrosis. 3D TEE was superior in identifying the partial posteromedial papillary muscle rupture.
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Havins et al. (2013) conducted a case report in Partial posteromedial papillary muscle rupture (n=1). Three-dimensional transesophageal echocardiography vs. Two-dimensional transesophageal echocardiography was evaluated on Identification of partial posteromedial papillary muscle rupture. Three-dimensional transesophageal echocardiography was superior to two-dimensional imaging in clearly identifying the partial posteromedial papillary muscle rupture and prolapsing valve scallops.
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