TEER for Severe Mitral Regurgitation With Cardiogenic Shock Caused by Bilateral Papillary Muscle Rupture.

BACKGROUND

Mitral regurgitation (MR) caused by bilateral papillary muscle (PM) rupture is a rare yet critical complication of acute myocardial ischemia.

CASE SUMMARY: A 75-year-old man developed spiral dissection of the left circumflex artery during percutaneous coronary intervention that led to posterior PM rupture. Emergency mitral transcatheter edge-to-edge repair (M-TEER) was performed under intra-aortic balloon pump support. During the procedure, after administration with 1 mg of epinephrine to treat hemodynamic instability, partial rupture of anterior PM occured again, resulting in increased regurgitation in area A1. The rotated 270° grasp technique was applied for bilateral PM rupture, and the severe MR decreased to a mild level.

DISCUSSION: In patients with severe MR caused by acute myocardial ischemia, positive inotropic agents should be applied cautiously because they may further exacerbate mechanical complications.

TAKE-HOME MESSAGES: Bilateral PM rupture during M-TEER is extremely rare. The rotated 270° grasp technique can further enhance the success rate of emergency M-TEER.