Double Rupture of a Tricuspid Papillary Muscle and Ventricular Septum: A Rare Combination after Myocardial Infarction

摘要

class="kwd-title">Keywords: Tricuspid regurgitation, Papillary muscle rupture, Ventricular septum rupture, Myocardial infarction class="head no_bottom_margin" id="sec1title">IntroductionAcute myocardial infarction (AMI) in the current era is managed using aggressive reperfusion therapies, including dual-antiplatelet therapy and primary percutaneous intervention, that permit prompt restoration of blood flow to the infarcted myocardium. Such interventions are responsible for the declining rate of ventricular septal rupture (VSR) from the prethrombolytic era to a now comparatively rare incidence., , , In addition to VSR, other mechanical complications depending on which coronary artery is occluded may ensue. Acute inferior wall ST-segment elevation myocardial infarction (STEMI) contributes to approximately 10% of STEMI's in-hospital mortality, and right ventricular (RV) infarction may occur in up to 50% of inferior wall STEMIs. Severe tricuspid valvular regurgitation (TR) may follow RV infarction. In such case, acute rupture of papillary muscle within the right ventricle should be high on differential diagnosis.Ischemic tricuspid papillary muscle rupture is rare, but it has been previously reported., To our knowledge, acute ischemic tricuspid papillary muscle rupture in conjunction with VSR has not been yet reported. Here we illustrate the utility of two and three-dimensional echocardiography in the diagnosis and management of a patient with hemodynamic instability in the setting of VSR and acute tricuspid papillary muscle rupture following an acute coronary event.