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ACUTE PAILLARY MUSCLE RUPTURE WITH SEVERE MR

ACUTE PAILLARY MUSCLE RUPTURE WITH SEVERE MR

72-year-old female presented with chest discomfort for which ECG was taken which revealed inferior wall myocardial infarction. She underwent emergency coronary angiogram which revealed 100% occlusion of right coronary artery. Since the right coronary artery was ectatic and torturus, balloon dilatation along with intracoronary thrombolysis. She was observed in ICU and was shifted to ward after 3 days of procedure. After one week patient had recurrent ventricular arrhythmia and pulmonary edema. She was shifted back to ICU and got intubated. Her ABG showed severe metabolic acidosis and echo revealed severe mitral regurgitation, chordae rupture, inferior wall hypokinesia, moderate RV/ LV dysfunction with moderate PAH. Since the patient was in severe cardiogenic shock, IABP was inserted and was taken up for emergency CABG with mitral valve replacement by Dr Srinath Vijayasekharan, Dr. Senthil Kumar and Team. Intraoperatively it was found to have posteromedial papillary muscle rupture leading to acute MR. Under cardiopulmonary bypass support, mitral valve replacement with 25 mm TTK Chitra valve and CABG was done. Postoperatively she required inotropic support which was gradually weaned. She also had acute kidney injury for which she required CRRT support. Her post operative course was stormy with multiple septic episodes, prolonged ventilatory support and multiorgan dysfunction. She gradually improved and got shifted to ward after more than a month of ICU stay. She required intense physiotherapy and rehabilitation in the ward to improve the muscle strength. Her tracheostomy tube was decannulated after two months of surgery and got discharged without any major complications. 

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