Role of echocardiography in diagnosis and management of complete papillary muscle rupture caused by myocardial infarction.

Aim To evaluate the usefulness of echocardiography in the diagnosis of complete rupture of papillary muscle. Methods Transthoracic (TTE) and transesophageal echocardiography (TEE) was performed with the ATL 3000 HDI Ultrasound Inc (Bothell, WA, USA) with a 2.5 MHz transducer and 5-7 MHz multiplane phased array transducer. We are reporting about two patients (a 45 and a 51-year old male) with complete ruptures of papillary muscle following acute myocardial infarction (AMI). Results Both patients were previously treated with fibrinolysis in their local hospitals, 400 and 300 km, respectively, away from our hospital. Massive mitral regurgitation developed in both followed by rapid deterioration of hemodynamic state and severe heart failure, because of which both were transferred by helicopter to the Coronary Care Unit of our clinic. The diagnosis of complete papillary muscle rupture was confirmed in both patients by TTE and TEE. Due to the significant deterioration in their hemodynamic state, vasoactive drugs and intra-aortic balloon pump support were applied. Both patients then underwent mitral valve replacement, accompanied by concomitant coronary artery bypass grafting in one case. Conclusion Transesophageal echocardiography is a more accurate and rapid diagnostic method in patients with mechanical complications of AMI than TTE. Cilj Procijeniti korisnost ehokardiografije u dijagnostici kompletne rupture papilarnog mišića. Metode Za transtorakalnu (TTE) i transezofagusnu ehokardiografiju (TEE) korišten je aparat ATL 3000 HDI Ultrasound Inc. (Bothell, WA, USA), sondama od 2,5 MHz i od 5 do 7 MHz. Opisana su dva muška bolesnika u dobi 45 i 51 godine s kompletnom rupturom papilarnog mišića u akutnom infarktu miokarda (AIM). Rezultati Oba bolesnika liječena su trombolitičkom terapijom zbog AIM-a u dvije lokalne bolnice udaljene 400, odnosno 300 km. Zbog masivne mitralne regurgitacije koja je uzrokovala hemodinamsku nestabilnost i zatajivanje srca teškog stupnja bolesnici su helikopterom transportirani u koronarnu jedinicu naše Klinike. Dijagnozu kompletne rupture papilarnog mišića potvrdili smo u oba bolesnika pomoću TTE-a i TEE-a. Zbog teškog općeg stanja i hemodinamske nestabilnosti bolesnici su primali vazoaktivu terapiju i priključeni su na intraaortalnu balon-crpku. U oba bolesnika implantirana je umjetna mitralna valvula, a aortokoronarno premoštenje učinjeno je u jednog bolesnika. Zaključak Transezofagusna ehokardiografija u odnosu na TTE je točna i brza dijagnostička metoda u bolesnika s mehaničkim komplikacijama u akutnom infarktu miokarda. [ABSTRACT FROM AUTHOR]