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Formica et al. Vessel Plus 2019;3:37 I http://dx.doi.org/10.20517/2574-1209.2019.19 Page 7 of 10

Figure 6. Transesophageal echocardiographic evidence of papillary muscle rupture

A B C

Figure 7. Surgical view of papillary position (A); posterior mitral leaflet and portion of papillary muscle (B); bi-leaflet prosthetic
mechanical valve in mitral position (C)

Table 3. Early and long-term outcome of papillary muscle rupture
Authors Patients In-hospital mortality Long-term survival
Bouma et al. [54] 48 2 (4.2%) -
Schroeter et al. [55] 28 11 (39.3%) -
Tavakoli et al. [56] 21 4 (19%) 5-year: 68%;
10-year: 56%
Russo et al. [57] 54 10 (18.5%) 5-year: 79%;
10-year: 55%

Surgical technique depends upon the location and the type of rupture. In case of partial PMR, surgeons
usually attempt for a repair of mitral valve. However, a surgical repair of the papillary muscle head is really
rare. In case of complete PMR, mitral valve replacement becomes the treatment of choice Figure 7 [53,54] .

Long-term survival of patients who underwent mitral valve replacement for PMR is very acceptable, with a
5-year survival rate ranging between 60%-70% [56,57] .

Table 3 reports the in-hospital mortality rates and long-term survival percentages of studies with relatively
large number of patients.

CONCLUSION
Mechanical complications after acute myocardial infarction are still affected by high 30-day mortality and
poor long-term survival. The incidence of such complications is reduced in the post thrombolysis era, but
the perioperative surgery continues to be relatively high. The diagnosis should be as prompt as possible,