A physiological approach to surgery for acute rupture of the papillary muscle |
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| Authors: | P A Spence C M Peniston N Mihic T E David A K Jabr D Archer T A Salerno |
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| Affiliation: | 1. Department of Surgery, University of Massachusetts-Baystate, Springfield, Massachusetts;2. Department of Surgery, Duke University, Durham, North Carolina;3. Duke Clinical Research Institute, Durham, North Carolina;4. Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan;5. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina;6. Department of Surgery, Atrium Health, Charlotte, North Carolina;7. Department of Surgery, Weill-Cornell Health, New York, New York;8. Department of Surgery, University of Maryland, Baltimore, Maryland;9. The Society of Thoracic Surgeons, Chicago, Illinois;1. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida;2. Division of Transplant Nephrology, University of Florida College of Medicine, Gainesville, Florida;3. Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida;1. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa;2. Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pa;1. Service de Cardiologie et Maladies Vasculaires, CHU Rennes, Rennes, France;2. Université de Rennes 1, Rennes, France;3. U1099, INSERM, Rennes, France;4. Service de chirurgie cardiaque et thoracique, Rennes, France;5. Department of Cardiac Surgery, Department of Cardiology, Cardiac Intensive Care Unit, Institut Coeur-Poumons, CHU Lille, Lille, France;6. Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France;7. Service de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Université Bordeaux II, Bordeaux, France;8. Département de chirurgie cardiovasculaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France;9. Department of Cardiac Surgery, Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France;10. Department of Cardiology and Heart Transplantation Unit, CHU Nantes, Nantes, France;11. Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France;12. Department of Cardiology and Cardiac Surgery, Bichat-Hospital, Paris, France;13. Department of Cardiac Surgery, La Timone Hospital, Marseille, France;14. Department of Cardiac Surgery, “Louis Pradel” Cardiologic Hospital, Lyon, France;15. Department of Cardiology and Cardiovascular Surgery, Hospital Charles Nicolle, Rouen, France;p. Department of Cardiology and Cardiac Surgery, University Hospital of Caen, University of Caen, Caen, France;q. Department of Cardiology and Cardiac Surgery, University Hospital Dijon Bourgogne, Dijon, France;r. Department of Cardiology and Cardiac Surgery, AP-HP CHU Henri Mondor, Créteil, France;s. Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France;t. Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France;u. Cardiology Department, European Georges Pompidou Hospital, Paris, France;v. Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, Nancy, France;2. Division of Cardiology, Department of Medicine, Duke University School of Medicine;3. Duke University School of Medicine, Durham, NC |
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| Abstract: | There is controversy regarding the optimal management of patients in whom acute papillary muscle rupture develops. This study evaluates the effect of division of the anterolateral papillary muscle on left ventricular (LV) function and compares two methods of treatment--mitral valve replacement (MVR) and mitral valve repair. Thirteen pigs were placed on cardiopulmonary bypass, and interventions were performed in an isolated beating heart preparation. LV function was assessed with a compliant intraventricular balloon at baseline, after division of the anterolateral papillary muscle (Divided), after repair of the divided papillary muscle (Repair), and finally after MVR. Division of the anterolateral papillary muscle caused a significant deterioration in LV function. Function was maintained at this level after mitral valve repair but deteriorated with MVR. Developed pressure measured at baseline was 179 +/- 13 mm Hg; Divided, 148 +/- 11 mm Hg (p less than 0.05 versus baseline); Repair, 149 +/- 15 mm Hg; and MVR, 95 +/- 8 mm Hg (p less than 0.05 versus Divided) at a balloon volume of 20 ml. These results suggest that LV function is impaired by papillary muscle rupture. Repair of the ruptured papillary muscle is associated with better LV function than is MVR. |
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