[HSF] Image of the week - Ischemic papillary muscle rupture

[Tohru Asai]

Roberto, Prasanna and Bob:
Thanks for inviting me to this thread! Yes, I am a surgeon who would have 
repaired it. Prasanna kindly uploaded my picture early in this year. I 
reproduced panorama pictures to enclose. Please look at these.
Points of my repair are relocation of fibrous origins of ruptured PM head to 
"other intact PM heads". There are often intact PM on ipsilateral side ( 
anterolateral or posteromedial ) even in the major basal rupture of PM lake 
your case. I transposed two heads ( responsible for A1 and A2) to intact 
heads for P1 and P2 using 4-0 Prolene transfixing sutures respectively. It 
worked out pretty well. This specific pathology demonstrates normal leaflet, 
normal chordae and normal (small) LA. Why you even think about Gore-Tex? 
Probably not essential.
Lesson I learned was as follows;
1. Severe MR with cardiogenic shock does not always mean “unrepairable 
valve”!
2. Large segment of prolapse does not always mean “unrepairable valve”!
3. A key for successful repair is to watch not ruptured PM but "other intact 
PM ".
Hope to show you my video at Geneva, if you are coming!
---
Tohru Asai

> Roberto, Tohru Asai sent a picture of a case similar to this some time
> back and he had successfully reimplanted it. He can give the details.

> Let see what happens, just look at the photo and tell me if anyone would
> have repaired it. The posterior wall of the ventricle was infarcted, the
> ventricle very dilated,I think a goretex cordae would have been risky.
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