[Surgery of post myocardial infarction papillary muscle rupture].

BACKGROUND

Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery.

AIM: To analyze our most recent surgical experience with papillary muscle rupture.

PATIENTS AND

METHODS

The database of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed.

RESULTS

Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2% of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study period. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class I-II.

CONCLUSIONS

Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and long-term mortality. However, survivors have good quality of life.