Key result
Transgastric TEE identifies posteromedial papillary muscle rupture missed by standard transthoracic and mid-esophageal views.
Why the study?
Accurate diagnosis of papillary muscle rupture after acute myocardial infarction is critical for urgent surgical intervention, but transthoracic echocardiography may have limitations in detailed evaluation of the mitral subvalvular apparatus.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
May facilitate diagnosis of missed papillary muscle rupture; leaves open whether transgastric views merit routine TEE protocols.
Transesophageal echocardiography was performed to evaluate the exact cause of severe mitral regurgitation in a 64-year-old man presented with hypotension and dyspnea after acute inferior wall myocardial infarction. In mid-esophageal two- and four-chamber view, the ruptured stump of papillary muscle could not be visualized. However, in transgastric two-chamber view, we could clearly visualize the ruptured head of the posteromedial papillary muscle as a separated mass attached by chorda tendinae, as well as the freely mobile stump of the ruptured papillary muscle within the left ventricle. So, the comprehensive transesophageal echocardiography, including transgastric imaging, is always indicated in patients with severe mitral regurgitation after acute myocardial infarction.
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Kim et al. (2002) conducted a case report in Papillary muscle rupture after acute myocardial infarction (n=1). Transgastric view of transesophageal echocardiography (TEE) vs. Transthoracic echocardiography and mid-esophageal TEE was evaluated on Visualization and diagnosis of papillary muscle rupture. Transgastric transesophageal echocardiography successfully visualized a ruptured posteromedial papillary muscle that was missed by transthoracic and mid-esophageal views.
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