Case report

Cardiogenic shock as a complication of acute mitral valve regurgitation following posteromedial papillary muscle infarction in the absence of coronary artery disease

Federico Bizzarri¹ , Consalvo Mattia² , Massimo Ricci¹ , Flaminia Coluzzi² , Vincenzo Petrozza³ , Giacomo Frati¹ , Giuseppe Pugliese¹ and Luigi Muzzi¹

¹  Cardiac Surgery Unit-Polo Pontino, Heart and Great Vessels Department, University of Roma "Sapienza", Via F. Faggiana 34, Latina-Italy

²  Anaesthesiology and Intensive Care Unit, Rome University "Sapienza"-Polo Pontino, Via F. Faggiana 34, Latina-Italy

³  Pathology Unit, Rome University "Sapienza", Via F. Faggiana 34, Latina-Italy

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Journal of Cardiothoracic Surgery 2008, 3:61doi:10.1186/1749-8090-3-61

Published:	4 November 2008

Abstract

A 48 year old man was transferred to our department with cardiogenic shock, pyrexia, a high white cell count and significant serum troponin T level. Clinical evaluation revealed severe mitral regurgitation secondary to a flail of both mitral valve leaflets. An emergency cardiac catheterisation did not reveal any significant coronary artery disease. Left ventricular angiogram and echocardiography demonstrated a good left ventricular function and massive mitral regurgitation. Blood cultures were negative for aerobics, anaerobics and fungi. The patient underwent emergency mitral valve replacement with a mechanical valve. Intraoperatively, the posteromedial papillary muscle was found to be ruptured. Histology of the papillary muscle revealed myocardial necrosis with no signs of infection. Cultures obtained from a mitral valve specimen were negative. The patient's recovery was uneventful and he was discharged on the 6^th postoperative day.