PMC9286937_01
Preoperative electrocardiogram reveals ST-segment elevation in leads I, aVL, and aVR (a). Preoperative chest radiographs reveal severe pulmonary congestion (b). Preoperative transesophageal echocardiography reveals severe mitral regurgitation due to papillary muscle rupture (c, d). The white arrow indicates the ruptured anterior papillary muscle.
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Electrocardiogram revealed ST-segment elevation in leads I, aVL, and aVR (Figure 1(a)). Chest radiographs showed severe bilateral pulmonary congestion (Figure 1(b)). Transthoracic and transesophageal echocardiography demonstrated severe mitral regurgitation due to PMR (Figures 1(c) and 1(d), Videos 1 and 2).
Coronary angiography reveals no significant stenosis in the right coronary artery (a) and left anterior descending artery and circumflex arteries (b), and stenosis of the high lateral branch (c) is observed. The yellow circle indicates the high lateral branch, and the yellow arrow indicates stenosis. LAD: left anterior descending artery; LCx: left circumflex artery; RCA: right coronary artery.
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However, no other lesions with significant stenosis were noted (Figure 2, Video 3).
Resected specimen reveals complete rupture of the anterior papillary muscle (a, b). The pathological findings of the resected anterior papillary muscle reveal ischemic changes and necrosis of the myocytes (c-e). The black quadrangle indicates the area of (d), and the white quadrangle indicates the area of (e). MV: mitral valve; PM: papillary muscle.
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However, no other lesions with significant stenosis were noted (Figure 2, Video 3). Paul, MN, USA). Pathological examination of the resected PM revealed ischemic changes and necrosis of the myocytes almost entirely with features such as wavy fibers, loss of nuclei, and striations (Figure 3).