Fully percutaneous emergency management of an acute myocardial infarction complicated by papillary muscle rupture treated with percutaneous revascularization and mitral transcatheter edge-to-edge repair: a case report

Papillary muscle rupture (PMR) in a rare and life-threatening complication of a myocardial infarction (MI). In our case we describe a complete percutaneous emergency management of this complication with coronary angioplasty followed to successful MitraClip repair.

We report a case of a 62-year-old man with MI and severe mitral regurgitation. We performed percutaneous revascularization and intra-aortic balloon pump (IABP) was placed. After a transthoracic and transoesophageal echo evaluation, a PMR was diagnosed. Due to intractable pulmonary oedema, we proceed to emergency mitral edge-to-edge repair with two MitraClip just 2 h later. Mitral regurgitation was reduced to mild, and patient was extubated.

This case reports a completely percutaneous management of an MI complicated by PMR in prohibitive surgical risk patient. Emergency treatment of MI and PMR with coronary angioplasty and MitraClip is feasible and could be a bail-out option in high surgical risk patients.