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Archives of cardiovascular diseases
Volume 107, n° 5
pages 340-342 (mai 2014)
Doi : 10.1016/j.acvd.2012.05.015
Received : 18 April 2012 ;  accepted : 10 May 2012
Unusual presentation of posterior papillary muscle rupture
Présentation inhabituelle de rupture de pillier (muscle papillaire) postérieur
 

Figure 1




Figure 1 : 

A. Preoperative coronary angiography showing acute occlusion in the first obtuse marginal artery (left box, white arrow). After on-site percutaneous ballooning, blood flow was restored (middle box, arrowhead). The posterior descending artery was supplied by the right coronary artery, thus this coronary system had right dominance (right box). B. Preoperative echocardiogram revealed acute mitral regurgitation with suspicious papillary muscle rupture (arrow) and regurgitant jet flow was noted in the colour Doppler image (upper small image). C. Preoperative chest X-ray showing pulmonary oedema and intra-aortic balloon pump (arrow).


Figure 2




Figure 2 : 

A. Intraoperative exploration revealed completely ruptured posteromedial papillary muscle (arrow) in the left atrium. B. Histopathological finding of ruptured papillary muscle. Myocytes show contraction band necrosis, an early histological change in acute myocardial infarction. Note that a dark contraction band (arrow) extends across the myocytes, and the nuclei are not clearly visible in most of the cells. The arrowhead indicates myocytolysis with the infiltration of macrophage (haematoxylin and eosin stain, ×400).

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