VV-ECMO Combined With M-TEER for the Treatment of Mitral Valve Papillary Muscle Rupture Following Acute Myocardial Infarction PCI: A Case Report.

Mitral valve papillary muscle rupture represents a rare yet critical complication of acute myocardial infarction, often leading to severe mitral regurgitation and subsequent pulmonary edema with high mortality. Despite optimal ventilatory support and pharmacological management, patients often exhibit refractory hypoxemia, rendering surgical intervention both technically demanding and high-risk. A 40-year-old Asian male presented to the emergency department of Liaocheng People's Hospital following percutaneous coronary intervention (PCI) for acute myocardial infarction at an outside facility. Shortly post-procedure, the patient developed dyspnea and oliguria. Despite endotracheal intubation, mechanical ventilation, and medical therapy, his condition deteriorated, necessitating transfer. Echocardiography and transesophageal echocardiography confirmed mitral valve papillary muscle rupture with severe regurgitation, complicated by profound pulmonary edema and refractory hypoxemia. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was promptly initiated, resulting in gradual improvement in oxygenation. Following a multidisciplinary evaluation, edge-to-edge mitral valve repair was successfully performed under VV-ECMO support. ECMO was discontinued on postoperative day 4, and the patient was discharged after 14 days with marked clinical improvement. In cases of severe pulmonary edema secondary to mitral valve papillary muscle rupture post-PCI for acute myocardial infarction, early VV-ECMO implementation combined with edge-to-edge mitral valve repair under ECMO support may mitigate surgical risk and enhance outcomes. This integrated approach presents a viable therapeutic alternative for such high-risk patients.