Acute severe mitral regurgitation: consideration of papillary muscle architecture

We present a case of an individual who presented with acute severe mitral regurgitation in the setting of an inferior ST elevation myocardial infarction. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet attached presumably to the anterior papillary muscle. Intraoperative findings demonstrated rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet. This case serves to remind us that both the anterior and posterior leaflets of the mitral valve are attached to both papillary muscle heads. The direction and eccentricity of the mitral regurgitant jet on echocardiography helps to locate the leaflet involved, but not necessarily the coexisting papillary muscle pathology

The mean S' at presentation, prior to revascularization, was higher in the survivors as compared to those patients who died (3

5 ± 0.5 vs. 1.8 ± 0.5 cm/s).<p><b>Copyright information:</b></p><p>Taken from "Clinical utility of tissue Doppler imaging in patients with acute myocardial infarction complicated by cardiogenic shock"</p><p>http://www.cardiovascularultrasound.com/content/6/1/11</p><p>Cardiovascular Ultrasound 2008;6():11-11.</p><p>Published online 20 Mar 2008</p><p>PMCID:PMC2311277.</p><p></p