25793030 Visualization

We present the case of a 66 Age - year Age - old Age female Sex patient with no History significant History past History medical History history History presenting Clinical_event with chest Biological_structure pain Sign_symptom that was treated with antacids Medication by her primary Nonbiological_location care Nonbiological_location physician Nonbiological_location .
The next Date day Date she presented Clinical_event to the emergency Nonbiological_location room Nonbiological_location , where an electrocardiogram Diagnostic_procedure revealed posterolateral Detailed_description ST Detailed_description elevation Detailed_description myocardial Disease_disorder infarction Disease_disorder .
The patient was immediately taken Clinical_event to the catheterization Nonbiological_location lab Nonbiological_location .
A successful percutaneous Therapeutic_procedure intervention Therapeutic_procedure was performed on an acutely Severity occluded Sign_symptom large Biological_structure ramus Biological_structure intermedius Biological_structure vessel Biological_structure that was supplying Sign_symptom a large portion of the lateral Biological_structure wall Biological_structure (Figure 1).
The patient did Sign_symptom well Sign_symptom initially Detailed_description , but several Time hours Time later Time she suddenly Lab_value went into cardiogenic Disease_disorder shock Disease_disorder .
An intra Therapeutic_procedure - aortic Therapeutic_procedure balloon Therapeutic_procedure pump Therapeutic_procedure was placed, and an echocardiogram Diagnostic_procedure demonstrated that she had severe Severity mitral Disease_disorder regurgitation Disease_disorder from a ruptured Disease_disorder papillary Biological_structure muscle Biological_structure (Figure 2).
The patient, on maximal Lab_value support Therapeutic_procedure , deteriorated Sign_symptom rapidly Severity with progressive Lab_value acidosis Sign_symptom , oliguria Sign_symptom , and florid Detailed_description pulmonary Biological_structure edema Sign_symptom .
In spite of the very high risk, we decided to intervene surgically.
Once in the operating Nonbiological_location room Nonbiological_location , transesophageal Biological_structure echocardiography Diagnostic_procedure confirmed severe Severity mitral Disease_disorder regurgitation Disease_disorder with a ruptured Disease_disorder anterolateral Biological_structure papillary Biological_structure muscle Biological_structure and a small Sign_symptom left Biological_structure atrium Biological_structure .
Shortly after the patient was put on cardiopulmonary Therapeutic_procedure bypass Therapeutic_procedure , the acidosis Sign_symptom resolved and she began to make Clinical_event urine Clinical_event .
Excellent visualization Diagnostic_procedure of the mitral Biological_structure valve Biological_structure was obtained using a vertical Detailed_description transseptal Detailed_description approach Detailed_description through the right Biological_structure atrium Biological_structure .
The valve Coreference was carefully inspected Diagnostic_procedure and the necrotic Sign_symptom ruptured Disease_disorder anterolateral Biological_structure papillary Biological_structure muscle Biological_structure was seen (Figure 3).
There was a large Severity chunk Biological_structure of Biological_structure muscle Biological_structure attached Sign_symptom to the A1 Biological_structure chordal Biological_structure apparatus Biological_structure .
The anterior Biological_structure leaflet Biological_structure of Biological_structure the Biological_structure mitral Biological_structure valve Biological_structure was excised Therapeutic_procedure while keeping the posterior Biological_structure leaflet Biological_structure intact Sign_symptom .
A 27 Distance - mm Distance St Detailed_description Jude Detailed_description Epic Detailed_description bioprosthesis Therapeutic_procedure was inserted (Figure 4).
She was placed on extracorporeal Therapeutic_procedure membrane Therapeutic_procedure oxygenation Therapeutic_procedure that was successfully weaned Therapeutic_procedure 3 Date days Date later Date .
Following this, she made a remarkable early Lab_value recovery Sign_symptom .
One Date month Date later Date , just prior to discharge Clinical_event , she expired Outcome after developing pneumonia Disease_disorder that progressed to sepsis Disease_disorder with multiorgan Disease_disorder failure Disease_disorder .