PMC6480979_01
(A-C) Cardiac catheterization displaying nonobstructive coronary artery disease. (D) TTE parasternal long axis (PLAX) view of mitral value displaying flail A2/A3 segment (arrow). (E) Parasternal short axis (PSAX) view displaying ruptured posteromedial papillary muscles (PMPM; arrow). (F and G) TEE displaying ruptured PMPM (arrow). (H) TEE displaying severe mitral regurgitation with a posterior medially directed jet due to ruptured PMPM (arrow). (I) CMR short axis view demonstrating subendocardial late gadolinium enhancement involving basal to mid-inferolateral wall (arrow).
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PMC6480979_01_10.1177_2324709619842247-fig1.jpg
fig1-2324709619842247
Coronary angiogram showed no significant atherosclerotic disease (Figure 1A-C). The left ventricular ejection fraction of 42% with a significantly elevated right ventricular systolic pressure of 85 mm Hg (Figure 1D and E). A transesophageal echocardiogram (TEE) demonstrated a flail A2/A3 segment of mitral valve and a ruptured posteromedial papillary muscle (Figure 1F and G). Severe MR was present, which was posteromedially directed along with pulmonary venous systolic flow reversal consistent with severe MR (Figure 1H). Cardiac magnetic resonance imaging (CMR) demonstrated subendocardial late gadolinium enhancement involving basal to mid-inferolateral wall of the left ventricle (Figure 1I).