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Case Reports
. 2022 Jul 8;17(1):173.
doi: 10.1186/s13019-022-01854-2.

Acute mitral valve regurgitation secondary to papillary muscle rupture due to infective endocarditis

Farshad Amirkhosravi  1 , Qasim Al Abri  2 , Alexander J Lu  3 , Lamees I El Nihum  3 , Renee K Eng  4 , Moritz C Wyler von Ballmoos  2 , Mahesh K Ramchandani  5
Affiliations
Case Reports

Acute mitral valve regurgitation secondary to papillary muscle rupture due to infective endocarditis

Farshad Amirkhosravi et al. J Cardiothorac Surg. .

Abstract

Background: Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines.

Case presentation: This case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge.

Conclusion: In patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.

Keywords: Case report; Infective endocarditis; Mitral regurgitation; Papillary muscle rupture.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Mitral valve imaging. Flail anterior mitral valve leaflet is seen on transesophageal echocardiogram (A) with evidence of a posteriorly directed regurgitant jet (blue) on transthoracic echocardiogram (B)
Fig. 2
Fig. 2
Resected papillary muscle and mitral valve
Fig. 3
Fig. 3
Histological evaluation of the papillary muscle. Histologic findings revealed myocardial necrosis with histiocytic inflammation (A, B), calcification (C), and valvular tissue with myxoid degeneration (D)
See this image and copyright information in PMC

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