Papillary muscle avulsion following balloon mitral valvotomy evaluated with three-dimensional echocardiography

Abstract

Background: Percutaneous balloon mitral valvotomy is a common therapeutic approach for rheumatic mitral stenosis. Avulsion of the papillary muscle is a rare but serious complication of balloon mitral valvotomy. The papillary muscles are derived from the trabecular layer of the developing ventricular walls. When subjected to a force, avulsion of papillary muscle from the trabecular layer may occur.

Case presentation: In this case report, we describe a patient with rheumatic mitral stenosis, who experienced avulsion of the mitral papillary muscle from the left ventricular wall after undergoing balloon mitral valvotomy. Papillary muscle alvusion resulted in severe mitral regurgitation, which was finally treated by mitral valve replacement.

Conclusion: We successfully diagnosed avulsion of the papillary muscle following balloon mitral valvotomy. Three-dimensional transthoracic echocardiography provides more information on mitral apparatus structure than two-dimensional transthoracic echocardiography.

Keywords: Alvusion; Balloon mitral valvotomy; Papillary muscle.

Fig. 1

a Three-dimensional transesophageal echocardiography revealing mitral stenosis. b Transthoracic echocardiography revealing avulsion of the papillary muscle from the left ventricular wall. c Color Doppler Flow Imaging revealing severe mitral regurgitation (yellow arrow). d Three-dimensional echocardiogram revealing papillary muscle avulsion (blue arrows)