Document Detail


Simultaneous papillary muscle avulsion and free wall rupture during acute myocardial infarction. Intra-aortic balloon pump: a bridge to survival.
MedLine Citation:
PMID:  16598115     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Mechanical complications of acute myocardial infarction (AMI) are rare, but often fatal. Medical therapy does not provide adequate risk reduction, and surgical correction is recommended when feasible. Supplemental hemodynamic support utilizing intra-aortic counterpulsation with a balloon pump provides an improvement in morbidity and mortality when combined with a corrective surgical approach. We report a case of an elderly male with a progressive 2-week history of ischemic symptoms presenting with acute pulmonary edema, hypotension and an inferior wall ST-elevation MI. His hospital course was complicated by ischemic mitral regurgitation (MR) and cardiogenic shock, which resulted in a papillary muscle rupture/avulsion from the inferolateral myocardial wall, and a communication for blood from ventricle to pericardial space. Initial management included mechanical ventilation, pharmacologic inotropic support, percutaneous revascularization of the culprit lesion and intra-aortic balloon counterpulsation. The patient underwent further successful cardiovascular surgical correction of his incompetent mitral valve, free wall rupture and other obstructive coronary arteries, leading to discharge and survival. Mechanical complications from AMI and the role of intra-aortic balloon support are discussed.
Authors:
John P Liuzzo; Yong T Shin; Christopher Choi; Sanjaykumar Patel; Robert Braff; John T Coppola
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  18     ISSN:  1557-2501     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-04-06     Completed Date:  2006-06-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  135-40     Citation Subset:  IM    
Affiliation:
Comprehensive Cardiovascular Center at Saint Vincent Catholic Medical Centers, New York, New York, USA. jl2697@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary*
Cardiac Surgical Procedures*
Heart Injuries / etiology*
Humans
Intra-Aortic Balloon Pumping*
Lacerations / complications,  etiology*,  surgery
Male
Mitral Valve Insufficiency / etiology,  surgery
Myocardial Infarction / complications,  pathology*,  therapy*
Papillary Muscles / pathology*
Rupture, Spontaneous

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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