Effects of Hyperthyroidism on Contractility and Na+/Ca2+ Exchanger Activity in the Isolated Papillary Muscle of Rats

Abstract Background: Hyperthyroidism (Hy) is an endocrine disorder, in which the thyroid hormones markedly alter the cardiac function. Increased myocardial contractility and cardiac output, improvement in diastolic relaxation, changes in electrical activity, increments in ventricular mass, and arrhythmias have been reported. However, the influences of thyroid hormones upon molecular mechanisms of cardiac functions have not yet been fully understood. Objectives: To evaluate changes in cardiac contractile parameters and the Na+/Ca2+ exchanger (NCX) function in induced hyperthyroid rats. Methods: Hy was induced by intraperitoneal injections of T3 (15 μg/100 g) for 10 days. Contractile parameters and NCX function were evaluated in the isolated papillary muscle. Data normality was confirmed by the Shapiro-Wilk test. The comparison between groups was performed through an unpaired Student's t-test. Results are expressed as mean ± SD. The accepted significance level was p < 0.05. Results: Our data revealed, in the Hy group, an increase of 30.98% in the maximum speed of diastolic relaxation (-284.64 ± 70.70 vs. -217.31 ± 40.30 mN/mm2/sec (p = 0.027)) and a boost of 149% in the NCX function in late phase of relaxation (20.17 ± 7.90 vs. 50.22 ± 11.94 minutes (p = 0.002)), with no changes in the maximum twitch force (p = 0.605) or maximum speed of systolic contraction (p = 0.208) when compared to the control. Conclusion: The improvement in relaxation parameters is hypothetically attributed to an increase in Sarco-Endoplasmic Reticulum Ca2+ATPase isoform 2 (SERCA2) expression and an increased calcium flow through L-type channels that boosted the NCX function.

Mortality rates of surgical techniques for correcting atrioventricular disjunction

Abstract We compared the mortality rates of two surgical techniques for correction of atrioventricular disjunction in 10 out of 720 patients who underwent mitral valve replacement from 2005 to 2012. In group I, the mitral annulus was fixed with bovine pericardial strips; in group II, a 'patch' of bovine pericardium was sutured and extended from the base of the lateral and medial papillary muscles, covered the posterior wall of the left ventricle, went through the posterior mitral annulus, and ended in the posterior wall of the left atrium adjacent to the mitral ring. The group II technique showed a lower mortality.

Disparity In Morphology Of Papillary Muscles Of The Mitral Valve Complex With Surgical Significance

Background: The mitral valve apparatus, consisting of the mitral valve leaflets and commissures and subvalvular apparatus- papillary muscles and chordae tendinae; is one of the most complex and intricately designedstructures present in the human body and therefore the understanding of anatomical variations of papillarymuscles becomes important for surgical interventional procedures, in response to the increasing incidence ofvalvular heart defects. The aim of the cadaveric analysis was to identify the disparity in the morphometry of thepapillary muscles of the mitral valve complex. Therefore this study was taken up with an effort to extend theconcepts previously presented as well as to overcome deficiencies in the knowledge of gross architecture andpositional nomenclature of the papillary muscles.Materials and methods: Fifty formalinized cadaveric hearts were the material for study. Papillary muscles of leftventricle were classified according to a system developed by Berdajs et al., (2005), by precisely measuringshapes lengths and widths.Results: The significant outcome of this study indicates that no two papillary muscles out of the 50 specimenshad the same size, shape or position. All the hearts had two distinct groups of muscles – anterolateral andposteromedial. Specific analysis of each group revealed data regarding the muscles. In the antero-lateral groupof the specimens, the maximum height and width of the muscles was 37.40mm and 17.06mm respectively and inthe postero-lateral group, 33.86 and 26.90mm respectively. Conical shaped muscles were the most commonlyfound muscles owing to the minimum obstruction posed by them to blood flow.Implication: Better understanding of morphological variations can help cardiothoracic surgeons to customizesurgical procedures according to the papillary muscle pattern of the individual patient

Batista procedure with the aid of intraoperative epicardial echocardiography

Abstract Introduction: The number of cases for which the Batista procedure is indicated is small, but some patients with appropriate indication can achieve good therapeutic results. Objective: To avoid incorrect left ventricular incision and obtain good surgical results in patients with dilated cardiomyopathy suitable for partial left ventriculectomy, we employed intraoperative direct echocardiography to determine the exact extent and position of the myocardial incision, even for surgeons who are not very experienced with the Batista procedure. Methods: A 72-year-old man with dilated cardiomyopathy underwent the Batista procedure with the aid of epicardial echocardiography to confirm the location of both the papillary muscles and the diseased myocardium. Results: We were able to accurately perform left ventricular incision and remove the diseased lateral ventricular wall. Two years later, the patient had no symptoms of heart failure, and his brain natriuretic peptide (BNP) level decreased from 1155 to 49.3 pg/mL. Conclusions: We believe that the use of intraoperative echocardiography may have the potential to make the Batista procedure less technically demanding and more reproducible for surgeons with little experience in the procedure.

Real-time three-dimensional transesophageal echocardiography in diagnosis of mitral papillary muscle rupture / 中国医学影像技术

Objective: To investigate the application value of real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) for diagnosing mitral papillary muscle rupture (PMR). Methods: Totally 35 patients with suspected PMR were enrolled. The mitral valve lesion and whether the lesion associated with PMR were evaluated with transthoracic echocardiography (TTE) and RT-3D-TEE preoperation. Taken surgical results as gold standards, the efficacy of preoperative RT-3D-TEE and TTE in diagnosis of mitral PMR were calculated. Results: PMR was confirmed in 25 cases by cardiac surgery, including 23 cases of posteromedial PMR and 2 cases of anterolateral PMR, while complete PMR was observed in 1 case and partial PMR in 24 cases. Mitral valve replacement was performed in 23 patients, while mitral valve repairment was performed in 2 patients. Ten cases were found without mitral PMR. Preoperation RT-3D-TEE and TTE diagnosed 23 and 20 cases of PMR, respectively. The compliance rate with surgical findings were statistical different between RT-3D-TEE (92.00% [23/25]) and TTE (80.00% [20/25]; P=0.033). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Youden index of RT-3D-TEE in preoperative diagnosis of PMR was 92.00% (23/25), 100% (10/10), 94.29% (33/35), 100% (23/23), 83.33% (10/12) and 0.92, which of TTE was 80.00% (20/25), 90.00% (9/10), 82.86% (29/35), 95.24% (20/21), 64.29% (9/14) and 0.70, respectively. Conclusion: RT-3D-TEE can accurately depict ultrasonic features of mitral valve anatomy and pathology from different angles and viewpoints, which is an effective method for confirming mitral PMR and providing reliable information for preoperative diagnosis, intraoperative monitoring and postoperative evaluation of PMR.

Correction of left ventricular outflow tract obstruction caused by anomalous papillary muscle and subaortic membrane

Abstract This paper presents a case study of a 30-year-old male patient with dyspnea on exertion had echocardiographic diagnosis of aortic subvalvar stenosis. Discrete mitral regurgitation and aortic valve dysplasia with mild to moderate insufficiency and hypertrophic cardiomyopathy were also noted. During surgery, a rare condition was identified: presence of papillary muscle anomaly associated with the subaortic membrane as a cause of obstruction of the left ventricular outflow tract. With the resection of these structures and a mitral valve annuloplasty, the patient evolved with a significant improvement of clinical condition and heart failure, with no residual mitral insufficiency.

Papillary muscles of left ventricle—Morphological variations and it’s clinical relevance

Introduction The two left ventricular papillary muscles are small structures at sternocostal and inferior wall but are vital to mitral valve competence. Extra papillary muscles could be found. Partial or complete rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, potentially correctable by surgery. Detailed knowledge of normal anatomy and variations is vital for accurate interpretation of information by echocardiography and for surgical repair. Materials and methods The material for present study consisted of 52 formalin fixed adult apparently normal cadaveric hearts belonging to either sex obtained from the Department of Anatomy. These hearts were dissected carefully to open the left ventricle and to expose the papillary muscles. According to their attitudinal position they were described as supero-lateral (S-L) and inferoseptal muscle (I-S) instead of conventional anterolateral and posteromedial. Different morphological features of papillary muscles were noted and measurements were taken. Results Classical picture of left ventricular papillary muscle was found only in 25% cases. Additionally extra muscles were found 34.61% and 71.15% in S-L and I-S group, respectively. Different shapes and pattern of papillary muscles were also been identified. An additional attribute of this study was measurement of length and breadth of papillary muscles which thus provides a base line data for further detailed studies in a large scale. Conclusion Oriental nomenclature is necessary not only for anatomist but also for electrocardiographers. Breadth of papillay muscle should be taken into morphometric account as for screening of hypertrophic cardiomyopathy. Proper anatomical knowledge is crucial for clinicians, surgeons and radiologists.

Ventricular arrhythmias originating from left ventricle posterior papillary muscle:electrocardiographic characteristics and catheter ablation / 中国介入心脏病学杂志

Objective To investigate the clinical characteristics, electrocardiography, electrophysiological features and the eff ectiveness of catheter ablation of ventricular arrhythmias originating from left ventricle posterior papillary muscles. Methods Clinical features and electrocardiography of 16 patients with ventricular arrhythmias arising from left ventricular posterior papillary muscles underwent catheter ablation were retrospectively analyzed. Activation mapping and/or pace mapping were performed to identify the site of origin and transthoracic echocardiography were used to demonstrate ablation catheter position and contact. The immediate success and recurrence rates were evaluated. Results During arrhythmias, QRS wave duration of 16 patients [5 men, mean age (45.0±18.2) years] was (155.1±9.0)ms. The prevalence of R>r' and r<R' of V1QRS morphology was 6/16 and 9/16, respectively. Earliest local ventricular electrogram preceded QRS wave by (30.8±8.4)ms at successful ablation site. Immediate success were achieved in 14 patients (14/16) ,11 patients(11/16) had full clinical follow-up and recurrences occurred in 5 patients (5/11). Conclusions Electrocardiography of ventricular arrhythmias originating from left ventricular posterior papillary muscles has its specifi c features. Earliest focal electrogram indicates successful ablation site and transthoracic echocardiography can demonstrate ablation catheter position and increase success rate but recurrence rate is still high.

Papillary Muscle Free Strain in Patients with Severe Degenerative and Functional Mitral Regurgitation / Free Strains de Músculos Papilares em Pacientes com Insuficiência Mitral Funcional e Degenerativa Grave

Abstract Fundamento: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. Objectives: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. Methods: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Results: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Conclusions: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

Resumo Fundamento: O papel da função do músculo papilar na regurgitação mitral grave com fração de ejeção do ventrículo esquerdo preservada e reduzida e o método de escolha para avaliar PM ainda são objetos de controvérsia. Objetivos: Avaliar e comparar a função dos músculos papilares entre pacientes com insuficiência mitral funcional e degenerativa pelo método free strain. Métodos: 64 pacientes com insuficiência mitral grave - 39 pacientes com insuficiência mitral degenerativa grave (grupo IMD) e 25 com insuficiência mitral funcional grave (grupo IMF) - e 30 indivíduos controle (grupo controle) foram incluídos no estudo. A função dos músculos papilares foi avaliada pelo método free strain a partir de imagens apicais quatro-câmaras do músculo papilar anterolateral (MPA) e imagens apicais três-câmaras do músculo papilar posteromedial (MPP). Strains circunferenciais e longitudinais globais do ventrículo esquerdo foram avaliados por meio de imagens bidimensionais a partir do rastreamento de conjunto de pontos de cinza (speckle tracking). Resultados: O strain longitudinal global do ventrículo esquerdo (grupo IMD, -17 [-14,2/-20]; grupo IMF, -9 [-7/-10,7]; grupo controle, -20 [-18/-21] p < 0,001); strain circunferencial global do ventrículo esquerdo (grupo IMD, -20 [-14,5/-22,7]; grupo IMF, -10 [-7/-12]; grupo controle, -23 [-21/-27,5] p < 0,001) e strains de músculos papilares (MPP; grupo IMD, -30,5 [-24/-46,7]; grupo IMF, -18 [-12/-30]; grupo controle; -43 [-34,5/-39,5] p < 0,001; MPA; grupo IMD, (-35 [-23,5/-43]; grupo IMF, -20 [-13,5/-26]; grupo controle, -40 [-32,5/-48] p < 0,001) mostraram-se significativamente diferentes nos grupos. MPA e MPP mostraram-se altamente correlacionados com a FEVE (p < 0,001, p < 0,00; respectivamente), SLG (p < 0,001, p < 0,001; respectivamente) e SCG (p < 0,001, p < 0,001; respectivamente) do VE entre todos os grupos. Não foi encontrada correlação entre os strains de músculos papilares e área eficaz do orifício (AEO) nos grupos de insuficiência mitral grave. Conclusões: A medição do strain longitudinal de músculos papilares pelo método free strain é prática e aplicável. A disfunção dos músculos papilares tem um papel pequeno em IM grave devido a causas degenerativas e funcionais, e a função dos músculos papilares, em general, parece seguir a função ventricular esquerda. O MPP é o MP mais afetado na insuficiência mitral em ambos os grupos, IMD e IMF.

Assessment of Papillary Muscle Function in Ischemic Mitral Regurgitation by Speckle Tracking Imaging Combined with Three-dimensional Ultrasonic Technology / 中国医学影像学杂志

Purpose To evaluate papillary muscle function in ischemic mitral regurgitation (IMR) with two-dimensional speckle tracking imaging (2D-STI) and three-dimensional ultraphonic technology,and to investigate the primary factors influencing IMR so as to provide clinical information for the prediction of IMR.Materials and Methods Seventy-six IMR patients were enrolled as research group and other 66 healthy volunteers as control group.Two groups were both examined by transthoracic echocardiography and 2D-STI.The parameters including fractional shortening of anterior and posterior papillary muscles (AFS,PFS),length of anterior or posterior papillary muscle tips to contralateral anterior mitral annular (APM-AMA,PPM-AMA),mitral leaflet closure (MLC),inter distance papillary muscle (IPMD),the angle between the anterior papillary muscle and the anterior LV free wall (Ang Ⅰ) and the angle between the posterior papillary muscle and the anterior LV free wall (Ang Ⅱ),anterior and posterior papillary muscle longitudinal strain (ALS,PLS) and peak time (APT,PPT),delay time (DT),left ventricular end-diastolic diameter (LVIDD),left ventricular end-diastole volume (LVEDV),and left ventricular ejection fraction (LVEF) were compared.Results Compared with control group,LVIDD,LVEDV,LVEF,AFS,PFS,IPMD,MLC,ALS,PLS and DT in research group were all significantly different (all P＜0.05).ALS,PLS,AFS,and PFS had positive correlation with LVEF (P＜0.05) and negative correlation with LVEDV (P＜0.05).MLC,IPMD,DT had negative correlation with LVEF (P＜0.05).ALS,PLS,MLC,AFS,PFS,IPMD were significantly correlated with Gensini score (r=-0.65,-0.78,0.54,-0.51,-0.57,0.49,respectively,P＜0.05).The multivariant Logistic regression analysis showed that IMR was correlated with IPMD,MLC,PLS and DT (OR=1.26,1.32,1.37,1.52,respectively,P＜0.05).Conclusion 2D-STI can accurately evaluate the papillary muscle dysfunction caused by myocardial ischemia.Moreover,the risk factors of IMR include increase of IPMD and MLC,decrease of PLS,and desynchronization of papillary muscles.These findings contribute to the clinical prediction of IMR.

Three-dimensional ultrasound guided catheter ablation of premature ventricular components originating from left anterior ventricular papillary muscles via transspetal puncture / 中国介入心脏病学杂志

Objective To investigate ablation characteristics of PVC/VT originating from left ventricle anterior papillary muscles.Methods This study included 10 patients of PVC/VT originating from left ventricle anterior papillary muscles from January 2015 to June 2016 in Beijing Anzhen Hospital.Electrophysiological mapping and radiofrequency ablation were completed using three-dimensional anatomical mapping system combined with three-dimensional intracardiac ultrasound technology.ECG and abaltion target diagram characteristics as well as the special anatomy were explored.Results All the 10 patients were successfully ablated and followed up for 12 months.One patient had recurrence within 12 months and no complications were recorded.The target sites localized at the tip (n =1),middle portion(n =4)or the base (n =5) of the LV-APM.Among 7 patients,the target sites were located at the anterior septal papillary muscle and in 3 patients were located in the free papillary muscle.9 patients were successfully ablated via anterograde trans-septal catheterization after the failure of retrograde approach.Premature QRS wave time were 152.80 ± 11.72 ms and 6 patients presented sharp potential at the targets during PVC/VT.Conclusions PVC/VT originating from left ventricle anterior papillary muscles have similar ECG and diagram characteristics that is different from which originating from left anterior fascicle.It is recommended to get the target via transseptalpuncure approach.Ablation target could be clearly positioned by three-dimensional intracardiac ultrasound technology.

Treatment of Post-endoscopic Sphincterotomy Bleeding / 胃肠病学

In recent years,endoscopic technique has become a basic procedure for the diagnosis and treatment of biliary and pancreatic diseases,thus the procedure-related complications of ERCP and endoscopic sphincterotomy(EST) become prominent day by day. Post-EST bleeding is one of the most serious complications of the procedure,and its first line treatment involves a variety of endoscopic techniques,such as epinephrine or fibrin glue local injection,electric coagulation and heat probe,clamps and covered metal stents. If these are not successful,transcatheter arterial embolization or surgical operation should be considered. In this article,the above-mentioned treatment modalities of post-EST bleeding were reviewed.

Myocardial contractility impairment with racemic bupivacaine, non-racemic bupivacaine and ropivacaine. A comparative study

PURPOSE: To study racemic bupivacaine, non-racemic bupivacaine and ropivacaine on myocardial contractility. METHODS: Isolated Wistar papillary muscles were submitted to 50 and 100 mM racemic bupivacaine (B50 and B100), non-racemic bupivacaine (NR50 and NR100) and ropivacaine (R50 and R100) intoxication. Isometric contraction data were obtained in basal condition (0.2 Hz), after increasing the frequency of stimulation to 1.0 Hz and after 5, 10 and 15 min of local anesthetic intoxication. Data were analyzed as relative changes of variation. RESULTS: Developed tension was higher with R100 than B100 at D1 (4.3 ± 41.1 vs -57.9 ± 48.1). Resting tension was altered with B50 (-10.6 ± 23.8 vs -4.7 ± 5.0) and R50 (-14.0 ± 20.5 vs -0.5 ± 7.1) between D1 and D3. Maximum rate of tension development was lower with B100 (-56.6 ± 38.0) than R50 (-6.3 ± 37.9) and R100 (-1.9 ± 37.2) in D1. B50, B100 and NR100 modified the maximum rate of tension decline from D1 through D2. Time to peak tension was changed with NR50 between D1 and D2. CONCLUSIONS: Racemic bupivacaine depressed myocardial contractile force more than non-racemic bupivacaine and ropivacaine. Non-racemic and racemic bupivacaine caused myocardial relaxation impairment more than ropivacaine. .

A Morphological And Morphometric Study Of Right Ventricular Papillary Muscles In North Indian Region.

Abstracts: Background & Objective: Aim of present study was morphological and morphometric observation of papillary muscles of tricuspid valve of human heart. Methodology: This study was carried out in 36 human (24 males and 12 females) heart from adult cadavers, which were dissected according to standard technique. All papillary muscles were observed for their shapes, numbers and dimensions in centimeters. Data were tabulated and statistical comparison were done using “chi square” and “z” test. Results: The average length of anterior, posterior and septal papillary muscle was 1.42 ± 0.29 cm, 0.94 ± 0.23 cm and 0.18 ± 0.08 cm while average breadth of anterior, posterior and septal papillary muscle was 0.41± 0.12 cm, 0.29± 0.09 cm and 0.11± 0.01 cm respectively. The anterior papillary muscles presented 1 head in 27.78% and 2 heads in 25%, while posterior papillary muscles presented 1 head in 27.78% and 2 heads in 25%. All the septal papillary muscles presented with 1 head. Single anterior papillary muscle was found to be 97.22% while posterior papillary muscle was found to be single in 72.28% and double in 27.78. Septal papillary muscle was found to be single in 25% cases and absent in 38.89% cases. Conclusion: Data obtained from this study might be helpful for reparative surgical procedures of tricuspid valve.

Ruptura de músculo papilar antero lateral por endocarditis local: Presentación inusual de la endocarditis de válvula nativa / Rupture of the anterolateral papillary muscle due to focal infective endocarditis: An unusual presentation of native valve endocarditis

Se presenta en caso de un varón de 55 años con diagnóstico de insuficiencia mitral severa por ruptura de músculo papilar; los hallazgos operatorios mostraron vegetaciones múltiples en la cabeza del musculo papilar anterolateral con ruptura total del mismo y velos valvulares normales. La histopatología mostró infiltrado inflamatorio polimorfonuclear en el tejido endocárdico y miocárdico, además vegetaciones fibrinosas en la superficie del musculo papilar, el cultivo del tejido resultó positivo a K. pneumoniae, concluyéndose como endocarditis aislada por infección directa del músculo papilar. El paciente recibió tratamiento antibiótico por seis semanas y fue dado de alta a los 45 días del ingreso con grado funcional. (AU)

We report the case of a 55-year old male patient diagnosed of severe mitral valve insufficiency due to rupture of the papilar muscle. Surgical findings included multiple vegetations on the head of the antero-lateral papilar muscle with complete rupture of it and abnormal valve veils. Histoptahology revealed polymorphonuclear infiltrate on the endocardic and myocardic tissues, and fibrinous vegetations on the surface of the papilar muscle. Klebsiella pneumoniae was isolated from the papilar muscle. The patient received 6-weeks of treatment and was discharged after 45 days of being admitted with functional class. (AU)

Papillary muscle and left ventricular trabecular calcification in rheumatic mitral stenosis.

Calcification of mitral valve apparatus in rheumatic pathology is not uncommon but isolated papillary muscle calcification and surrounding trabeculation is very rarely seen. Here valve leaflets and annulus are not calcified. This signifies the involvement of other factors in initiation of calcification other than rheumatic scarring. It may be chronic ventriculopathy that leads to trabecular calcification which involves papillary muscle and may later involve annulus. Clinical significance is that in high risk cases balloon mitral valvuotomy can be given a chance rather than replacement of valve as annulus and leaflets are pliable.

Ruptured Tricuspid Valve Papillary Muscle in a Neonate with Intractable Persistent Fetal Circulation

Unguarded tricuspid regurgitation (TR) due to a flail tricuspid leaflet is a rare condition of newborn cyanosis. A high perinatal mortality has been associated with this fatal condition. But, there are feasible surgical repairs to improve survival. We report the case of a male full-term neonate with intractable hypoxia. He had profound tricuspid insufficiency and leaflet prolapse caused by a ruptured papillary muscle supporting the anterior leaflet of the tricuspid valve. He presented with severe cyanosis and respiratory distress immediately after birth. Despite medical management, the pulmonary vascular resistance was not decreased and a low cardiac output persisted. Initial stabilization was accomplished with nitric oxide and extracorporeal membrane oxygenation. The tricuspid valve repair surgery was successfully performed subsequently. TR resulting from papillary muscle rupture is a potentially lethal condition. Timely diagnosis and proper surgical treatment can be lifesaving.

Post-traumatic tricuspid regurgitation with anterior papillary muscle rupture, corrected by papillary muscle reimplantation / 고신대학교의과대학학술지

A 60-year-old male patient with blunt chest trauma was transferred to our facility because of unstable vital signs and pericardial effusion. These conditions occurred after orthopedic surgery to repair multiple left finger fractures at a local medical center. Trans-thoracic echocardiography showed severe tricuspid regurgitation and he underwent papillary muscle reimplantation and tricuspid annuloplasty open heart surgery for post-traumatic tricuspid regurgitation with anterior papillary muscle rupture. We report early surgical traumatic valve disease correction without complications.

Effect of Papillary Muscles and Trabeculae on Left Ventricular Measurement Using Cardiovascular Magnetic Resonance Imaging in Patients with Hypertrophic Cardiomyopathy

OBJECTIVE: To evaluate the influence of papillary muscles and trabeculae on left ventricular (LV) cardiovascular magnetic resonance (CMR) analysis using three methods of cavity delineation (classic or modified inclusion methods, and the exclusion method) in patients with hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS: This retrospective study included 20 consecutive HCM patients who underwent 1.5-T CMR imaging with short-axis cine stacks of the entire LV. LV measurements were performed using three different methods of manual cavity delineation of the endocardial and epicardial contours: method A, presumed endocardial boundary as seen on short-axis cine images; method B, including solely the cavity and closely adjacent trabeculae; or method C, excluding papillary muscles and trabeculae. Ascending aorta forward flow was measured as reference for LV-stroke volume (SV). Interobserver reproducibility was assessed using intraclass correlation coefficients. RESULTS: Method A showed larger end-diastole and end-systole volumes (largest percentage differences of 25% and 68%, respectively, p 0.05). CONCLUSION: In HCM patients, LV measurements are strikingly different dependent on whether papillary muscles and trabeculae are included or excluded. Therefore, a consistent method of LV cavity delineation may be crucial during longitudinal follow-up to avoid misinterpretation and erroneous clinical decision-making.