Ultra-Early Transcatheter Edge-to-Edge Repair Intervention With Mechanical Circulatory Support for Post-Infarction Papillary Muscle Rupture

BACKGROUND: Papillary muscle rupture is a rare but highly lethal mechanical complication of acute myocardial infarction. Transcatheter edge-to-edge repair (TEER) combined with mechanical circulatory support offers a new therapeutic option for high-risk patients. CASE SUMMARY: A 57-year-old man with acute inferior myocardial infarction developed cardiogenic shock due to posteromedial papillary muscle rupture. Under venoarterial extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump support, successful TEER was performed within 8 hours of diagnosis, reducing mitral regurgitation from severe to trace with immediate hemodynamic improvement, and the patient survived to discharge. DISCUSSION: The highlight of this case is the ultra-early TEER intervention performed under dual mechanical circulatory support. These findings suggest that ultra-early TEER may represent a feasible salvage strategy in highly selected patients with ECMO-dependent cardiogenic shock, although its generalizability requires further investigation. TAKE-HOME MESSAGES: Ultra-early TEER can be considered a potential bridging strategy in selected patients with papillary muscle rupture and refractory cardiogenic shock. Dual mechanical circulatory support can provide hemodynamic stabilization to facilitate TEER in critically ill patients.