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(Circulation. 2008;118:1519-1520.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

 
Papillary muscle rupture (PMR) after myocardial infarction (MI) is rare but deadly. Radical treatment for PMR is mitral valve surgery, which is associated with high operative mortality. PMR presentation is usually catastrophic, and diagnosis often is difficult because the murmur is heard inconsistently. Long-term outcome of surgery is uncertain because of the small sizes of the published series. Thus, clinical management is difficult, and surgical decisions may be tentative. To address these issues, we examined the outcome of 54 patients who underwent post-MI PMR surgery between 1980 and 2000 at our institution. We confirmed the seriousness of PMR presentation with shock, pulmonary edema, or cardiac arrest in 91%. Operative mortality was high but was lower with coronary artery bypass graft and tended to decrease in recent years, declining from 67% (before 1990 without coronary artery bypass graft) to 8.7% (after 1990 with coronary artery bypass graft). Another development was valve repair, feasible in 41% after 1990, but its impact on outcome cannot be determined because of the small sample. We compared the long-term outcome of operative survivors with that of patients with similar MI but without PMR who had survived the first 30 days after MI. This comparison showed identical 5-year survival and similar heart failure rates. Thus, our study, while emphasizing the seriousness of PMR, is encouraging: Recent surgery is more often reparative, has markedly improved operative risk with coronary artery bypass graft, and results in restoration of long-term life expectancy and morbidity to that of a similar but . . . [Full Text of this Article]

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