Repair of both papillary and free wall rupture following acute myocardial infarction.

A 60-year-old patient with rupture of the papillary muscle combined with free wall rupture secondary to myocardial infarction is described. Transesophageal echocardiography was useful in making the diagnosis. Surgery was performed 2 days after the onset of acute myocardial infarction, and patch reinforcement of the ruptured wall and mitral valve replacement were effective. Only one case of this type of double rupture has been reported, and this is the first case to have been repaired surgically. It may be unusual for double rupture to occur because the first rupture decreases wall stress to less than the normal level.