Miyokard Enfarktüsüne Bağlı Olmayan Mitral Papiller Kas Rüptürü
Özet
Papiller kaslar sistol esnasında atrioventriküler (AV) kapaklarda regürjitasyon olmaması için kapaklara destek olan ventriküler kaslardır. Bir kalpte toplam beş adet olan papiller kaslardan üç tanesi (anterior, posterior ve septal) sağ ventrikülde bulunup triküspit kapakla ilişkiliyken iki tanesi (anterolateral ve posteromedial) sol ventriküldedir ve mitral kapakla ilişki halindedir. Bu kasların herhangi bir nedenle komplet veya parsiyel olarak bütünlüğünün bozulması papiller kas rüptürü olarak adlandırılır. Papiller kas rüptürü esas olarak miyokard enfarktüsün (MI) mekanik komplikasyonları arasında olsa da enfektif endokardit gibi diğer antitelerden sonra da görülebilmektedir. Akut gelişen bir durum olup sol sistemde görülen papiller kas rüptürü akut mitral yetmezliği semptomatolojisiyle kliniğe yansır. Görüntülemede ekokardiyografide flail kapak görüntüsü ve kapağın ucunda vejetasyon benzeri imajla tanı konulabilir. Mitral yetmezlikle uyumlu Doppler verileri de ekokardiyografide elde edilir. Tedavisi acil mitral kapak onarımı veya replasmanı olup cerrahisiz mortalitesi yüksek seyretmektedir.
Papillary muscles are ventricular muscles that provide support to the atrioventricular (AV) valves during systole, preventing regurgitation. Of the five papillary muscles in the heart, three (anterior, posterior, and septal) are located in the right ventricle and are associated with the tricuspid valve, while two (anterolateral and posteromedial) are in the left ventricle and are connected to the mitral valve. The disruption of the integrity of these muscles, either partially or completely, due to any cause is termed papillary muscle rupture. Although papillary muscle rupture is primarily a mechanical complication of myocardial infarction (MI), it may also occur following other conditions, such as infective endocarditis. It is an acute event, and rupture involving the left-sided papillary muscles manifests clinically with symptoms of acute mitral regurgitation. Diagnosis is typically made via echocardiography, which reveals a flail valve appearance and vegetative-like structures on the valve. Doppler imaging findings consistent with mitral regurgitation further confirm the diagnosis. Treatment involves urgent mitral valve repair or replacement, as the condition carries a high mortality risk without surgical intervention.
Referanslar
Victor S, Nayak VM. Variations in the papillary muscles of the normal mitral valve and their surgical relevance. J Card Surg. 1995;10(5):597–607. DOI: 10.1111/j.1540-8191.1995.tb00642.x
Rusted IE, Scheifley CH, Edwards JE. Studies of the mitral valve. I. Anatomic features of the normal mitral valve and associated structures. Circulation. 1952;6(6):825–31. DOI: 10.1161/01.cir.6.6.825
Sanders RJ, Neubuerger KT, Ravin A. Rupture of papillary muscles: occurrence of rupture of the posterior muscle in posterior myocardial infarction. Dis Chest. 1957;31(3):316–23. DOI: 10.1378/chest.31.3.316
Yamazaki M, Fukui T, Mahara K, Takanashi S. Complete rupture of the anterolateral papillary muscle caused by coronary spasm. Interact Cardiovasc Thorac Surg. 2015;21(6):798–800. DOI: 10.1093/icvts/ivv237
Bizzarri F, Mattia C, Ricci M, Coluzzi F, Petrozza V, Frati G, et al. Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease. J Cardiothorac Surg. 2008;3:61. DOI: 10.1186/1749-8090-3-61
Kitada Y, Arakawa M, Miyagawa A, Okamura H. Ischaemic papillary muscle rupture without significant coronary artery lesion. Interact Cardiovasc Thorac Surg. 2019;29(6):971–2. DOI: 10.1093/icvts/ivz201
İştar H, Harmandar B. Traumatic Papillary Muscle Rupture Mimicking Infective Endocarditis. MMJ. Mugla Sitki Kocman University; 2024;11(1):38–9. DOI: 10.47572/muskutd.1292221
Lavie CJ, Gersh BJ. Mechanical and electrical complications of acute myocardial infarction. Mayo Clin Proc. 1990;65(5):709–30. DOI: 10.1016/s0025-6196(12)65133-7
David TE. Techniques and results of mitral valve repair for ischemic mitral regurgitation. J Card Surg. 1994;9(2 Suppl):274–7. DOI: 10.1111/j.1540-8191.1994.tb00940.x
Thompson CR, Buller CE, Sleeper LA, Antonelli TA, Webb JG, Jaber WA, et al. Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we use emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol. 2000;36(3 Suppl A):1104–9. DOI: 10.1016/s0735-1097(00)00846-9
DiSesa VJ, Cohn LH, Collins JJ, Koster JK, VanDevanter S. Determinants of operative survival following combined mitral valve replacement and coronary revascularization. Ann Thorac Surg. 1982;34(5):482–9. DOI: 10.1016/s0003-4975(10)62992-x
Czer LS, Gray RJ, DeRobertis MA, Bateman TM, Stewart ME, Chaux A, et al. Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation. 1984;70(3 Pt 2):I198-207.
Schroeter T, Lehmann S, Misfeld M, Borger M, Subramanian S, Mohr FW, et al. Clinical outcome after mitral valve surgery due to ischemic papillary muscle rupture. Ann Thorac Surg. 2013;95(3):820–4. DOI: 10.1016/j.athoracsur.2012.10.050
Referanslar
Victor S, Nayak VM. Variations in the papillary muscles of the normal mitral valve and their surgical relevance. J Card Surg. 1995;10(5):597–607. DOI: 10.1111/j.1540-8191.1995.tb00642.x
Rusted IE, Scheifley CH, Edwards JE. Studies of the mitral valve. I. Anatomic features of the normal mitral valve and associated structures. Circulation. 1952;6(6):825–31. DOI: 10.1161/01.cir.6.6.825
Sanders RJ, Neubuerger KT, Ravin A. Rupture of papillary muscles: occurrence of rupture of the posterior muscle in posterior myocardial infarction. Dis Chest. 1957;31(3):316–23. DOI: 10.1378/chest.31.3.316
Yamazaki M, Fukui T, Mahara K, Takanashi S. Complete rupture of the anterolateral papillary muscle caused by coronary spasm. Interact Cardiovasc Thorac Surg. 2015;21(6):798–800. DOI: 10.1093/icvts/ivv237
Bizzarri F, Mattia C, Ricci M, Coluzzi F, Petrozza V, Frati G, et al. Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease. J Cardiothorac Surg. 2008;3:61. DOI: 10.1186/1749-8090-3-61
Kitada Y, Arakawa M, Miyagawa A, Okamura H. Ischaemic papillary muscle rupture without significant coronary artery lesion. Interact Cardiovasc Thorac Surg. 2019;29(6):971–2. DOI: 10.1093/icvts/ivz201
İştar H, Harmandar B. Traumatic Papillary Muscle Rupture Mimicking Infective Endocarditis. MMJ. Mugla Sitki Kocman University; 2024;11(1):38–9. DOI: 10.47572/muskutd.1292221
Lavie CJ, Gersh BJ. Mechanical and electrical complications of acute myocardial infarction. Mayo Clin Proc. 1990;65(5):709–30. DOI: 10.1016/s0025-6196(12)65133-7
David TE. Techniques and results of mitral valve repair for ischemic mitral regurgitation. J Card Surg. 1994;9(2 Suppl):274–7. DOI: 10.1111/j.1540-8191.1994.tb00940.x
Thompson CR, Buller CE, Sleeper LA, Antonelli TA, Webb JG, Jaber WA, et al. Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we use emergently revascularize Occluded Coronaries in cardiogenic shocK? J Am Coll Cardiol. 2000;36(3 Suppl A):1104–9. DOI: 10.1016/s0735-1097(00)00846-9
DiSesa VJ, Cohn LH, Collins JJ, Koster JK, VanDevanter S. Determinants of operative survival following combined mitral valve replacement and coronary revascularization. Ann Thorac Surg. 1982;34(5):482–9. DOI: 10.1016/s0003-4975(10)62992-x
Czer LS, Gray RJ, DeRobertis MA, Bateman TM, Stewart ME, Chaux A, et al. Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation. 1984;70(3 Pt 2):I198-207.
Schroeter T, Lehmann S, Misfeld M, Borger M, Subramanian S, Mohr FW, et al. Clinical outcome after mitral valve surgery due to ischemic papillary muscle rupture. Ann Thorac Surg. 2013;95(3):820–4. DOI: 10.1016/j.athoracsur.2012.10.050
