Cirugía de la rotura de músculo papilar por infarto miocárdico

Resumen

Background: Papillary muscle rupture is a serious complication
of myocardial infarction whose only treatment is surgery. Aim: To analyze our most recent
surgical experience with papillary muscle rupture. Patients and Methods: The database of
our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle
rupture. Then, the clinical records and operating protocols were analyzed. Survival and
functional class of patients were assessed. Results: Twelve patients (7 men), aged 52 to 89
years, had papillary muscle rupture. They represented 2.2% of all mitral procedures for mitral
insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study
period. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior.
In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired.
In seven patients, myocardial revascularization was performed. Mean lapse between infarction
and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up
ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a
cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional
class I-II. Conclusions: Papillary muscle rupture is an uncommon complication of myocardial
infarction, with considerable operative and long-term mortality. However, survivors have good
quality of life