Surgical Treatment for Papillary Muscle Rupture after Myocardial Infarction with Sustained Ventricular Tachycardia / 日本心臓血管外科学会雑誌

ABSTRACT

We report an operative case of papillary muscle rupture after myocardial infarction with sustained ventricular tachycardia. A 56-year-old man referred to our emergency room in shock. Emergency CAG showed total occlusion of the left circumflex artery, in which we placed a metallic stent. Even after re-canalization of the coronary artery was achieved, circulation was unstable. IABP and PCPS were used to maintain the systemic circulation. Trans-esophageal echocardiography showed papillary muscle rupture and massive mitral regurgitation. Under total cardiopulmonary bypass and cardiac arrest, we performed mitral valve replacement with a 27mm SJM mechanical valve. PCPS was continued after surgical treatment because of pulmonary congestion. Since the patient's circulation and respiratory function improved, PCPS and IABP were removed on postoperative days 3 and 5. However, after removal of IABP, ventricular tachycardia appeared and IABP, PCPS were re-inserted. After adequate medication with Amiodarone and Carbedirol, ventricular tachycardia was controlled. PCPS and IABP were then removed uneventfully on postoperative days 14 and 19.