AMI with mitral regurgitation

AMI outlined papillary muscle lesions may produce varying degrees of mitral regurgitation. Coronary atherosclerotic heart disease cardiac catheterization about 3% a mitral regurgitation. Coronary heart disease caused by mitral regurgitation may be acute or chronic papillary muscle ischemia caused. AMI, the papillary muscles can acute ischemic necrosis and in a few hours disruption. Although tendons and flap leaves no abnormal lesions, but the corresponding parts of the mitral valve leaflets loss hoist function, infarction occurred in the early stage after showing serious mitral regurgitation. In cases of acute myocardial infarction, due to papillary muscle rupture suddenly and died of severe mitral regurgitation were about 0.4 ~ 5%. Although part of myocardial infarction patients papillary muscles caused avascular necrosis, but not immediately and completely broken, or because of a prolonged ischemia, The myocardial necrosis was gradually replaced by fibrous tissue, papillary muscle thinning, elongation, reduced systolic function or loss, in cardiac embolism after more than two months before showing mitral regurgitation. Cause pathogenesis ago, and after the papillary muscles within the top of each issued tendons connecting to the mitral valve leaflets brink Each papillary muscles were responsible for two mitral valve or the first half of the latter part of the tendons function. In ventricular contraction taut mitral valve to prevent the left edge of atrial overturned, have regurgitation. Papillary muscles ago, the blood supply from the left anterior descending branch of the diagonal line and the edge of the circumflex branch of support, Then papillary muscles within the blood supply is only from the right coronary artery after descending, So in the middle of coronary heart disease within the papillary muscle than before foreign papillary muscles more susceptible to ischemic lesions. About 80% of acute papillary muscle rupture occurred in the latter within the papillary muscles. Myocardial infarction caused by the fracture papillary muscle necrosis, have sharp mitral insufficiency, ventricular contraction blood from the left ventricle back into the left atrium, left ventricular output reduction, lowering blood pressure, showing serious shock, pulmonary vascular congestion, there pulmonary edema. Acute myocardial infarction caused only part of papillary muscle rupture, although by the papillary muscles stretch and stretch. ventricular contraction part of the mitral valve prolapse into the left atrium and mitral regurgitation have, but to a lesser extent. flow back to the small, the hemodynamic less affected. Some cases of myocardial infarction ischemic not papillary muscle rupture, fiber gradually replaced by scar tissue, muscle contraction loss, weak papillary muscles elongated, tendons and papillary muscles remain connected, but papillary muscle dysfunction, ventricular contraction of mitral valve prolapse can into the left atrium. However mitral regurgitant volume generally not too much slower disease progression, but has left the development of heart failure. This situation myocardial infarction after more than two months because of mitral regurgitation and surgical treatment of the more common cases. Papillary muscle rupture or dysfunction caused mitral regurgitation cases, accompanied ventricular free wall myocardial infarction. the scope and infarcted myocardial involvement thickness lot of difference to the transmural infarction or cerebral infarction, heart disease is limited to Endo, serious papillary muscle rupture of mitral regurgitation with ventricular septal perforation. ventricular free wall perforation or aneurysm merger exist. Clinical manifestations papillary muscle rupture in the onset of acute myocardial infarction after a few hours to two weeks suddenly showed acute pulmonary edema and / or low - blood pressure and shock symptoms. General situation deteriorated rapidly. Apical region to be heard emerging systolic murmur, conduction of the axilla. Papillary muscle rupture parts were easier to hear the noise, the apical region can often hear the first three heart sounds, chest X-ray examination revealed pulmonary edema, But the heart and the left atrium increases not uncommon. Right heart Swan-Ganz catheter floating checks showed elevated left atrial pressure, High pressure curve and sharp V-wave, but without the level from left to right ventricular shunt, may exclude ventricular septal perforation. Plane echocardiography examination can show that the mitral valve motion abnormalities. ventricular contraction after two valve failure of a marginal; differentiated papillary muscle can rupture and papillary muscle dysfunction. The former ventricular contraction, the lesion tendons and part of mitral valve leaflets over into the left atrium, before and after the valve failure of cooperation, With ventricular diastolic blood, he returned to left ventricle, and sometimes you can see much of the fault of papillary muscles attached to tendons, Accompanying valve next pan. Papillary muscle dysfunction cases showed papillary muscle contraction reduce ventricular systolic mitral valve leaflets at the edge of a poor, Myocardial free wall also shows movement disorders. Left ventricular angiography can be selectively clear diagnosis, mitral regurgitation severity, understanding of left ventricular wall motion abnormalities and the extent of the site to identify any aneurysm may exclude ventricular septal perforation. However, the severity of the case should take a cautious attitude, this is not appropriate for routine inspection. Selective coronary angiography to the same period the purposes of determining the need coronary bypass grafting location. Chronic papillary muscle ischemia caused by mitral regurgitation often occurred several months after myocardial infarction showing mitral regurgitation symptoms and signs. Early lesions may be intermittent symptoms arise, and mitral regurgitation of a steadily increasing extent. Left ventricular and atrial expanded significantly, heart dysfunction and showed heart failure. Treatment of papillary muscle rupture cases were not timely surgical treatment were about 75% to 24 hours after the onset of shock and die within the heart power failure; Some faults were better prognosis, after the onset of an approximately 50% of the patients could survive and the evolution of chronic ischemic mitral regurgitation. Coronary heart disease and mitral regurgitation, five-year survival rates of less than 50%. Surgical technique : papillary muscle rupture of acute mitral regurgitation cases, a serious condition, urgent surgical treatment. By the right heart Swan-Ganz catheter examination confirmed the diagnosis, should immediately aortic balloon pump. temporarily improve or maintain circulatory function, the combination of low temperatures during cardiopulmonary bypass surgery. Median chest incision, vertical saw sternum, pericardial incision, revealing the heart. Meanwhile, cut a great saphenous vein for grafting segregation. Then systemic heparin, and the inferior vena cava or right atrium catheter inserted primer blood or aortic catheter inserted for blood, CPB began with cold saline for heart deep down, placed on the ascending aorta block tongs, After ascending aortic root, insert the needle and injecting cold cardioplegic solution. First for the great saphenous vein-coronary artery branches of end-to-side anastomosis and then ditch room left atrium, with mitral valve, replaced by mechanical or biological valve. As mitral annular fragile and should suture through enough, when traction suture operation should be gentle, to avoid lacerations. cushioned small piece for the continuity of suture, with increased line fastness. Completed after mitral valve replacement, aortic cross-clamping removed from the clamp and restore blood circulation crown, and then some clamping the aorta, for the great saphenous vein-ascending aortic anastomosis. In valve replacement before streaming for the distal graft anastomosis can be exposed to avoid coronary heart branch overturned, had been planted in the artificial heart valve caused left ventricular myocardial infarct zone rupture. Chronic ischemic mitral substandard surgical operation depends on the disease situation. For the first coronary artery branches saphenous vein anastomosis, and then address the mitral valve, Ditch rooms are usually left atrium revealed mitral valve. Valvular disease confined to the flap leaves, for valve repair and / or valve reduction in girth. Lesions in the former valve broader scope, and required valve replacement. Merger and ventricular septal aneurysm perforation, the incision removed by left ventricular aneurysm, suture ventricular septal rupture, resection of the lesion and mitral papillary muscles, for valve replacement (Figure 1). Figure 1 aneurysm, and ventricular septal perforation ischemic mitral regurgitation ⑴ incision surgery for aneurysm; ⑵ aneurysm wall resection and suture septal Break; ⑶ reinforced panels for use heart of this interval suture; ⑷ with mitral and papillary muscle; ⑸ suture artificial mitral valve; ⑹ mitral valve replacement operation has been completed; ⑺ suture left ventricular incision surgical treatment : surgical mortality and myocardial infarction, Left ventricular function and the operation time is closely related. Myocardial infarction occurred within 1 week after surgery treatment, the mortality of 40%; 2 ~ 3 weeks after an operation, will be reduced to 30% in 2000. Chronic ischemic mitral regurgitation surgery for early mortality was 10 ~ 15%. Impact of surgical mortality factors interested functional hierarchy, left ventricular spurting scores, and age at the time of surgery and whether such aneurysm. After 3-year survival rate is about 50 ~ 65%, in most cases after one year of death.