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Ann Thorac Surg 1986;42:27-30
© 1986 The Society of Thoracic Surgeons

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Articles

A Physiological Approach to Surgery for Acute Rupture of the Papillary Muscle

From the Divisions of Cardiovascular Surgery, St. Michael's Hospital and Toronto Western Hospital and the University of Toronto, Toronto, Ont, Canada

Accepted for publication September 6, 1985.

^* Address reprint requests to Dr. Salerno, Cardiovascular Surgery, St. Michael's Hospital, 30 Bond St, Toronto, Ont, Canada M5B 1W8

There is controversy regarding the optimal management of patients in whom acute papillary muscle rupture develops. This study evaluates the effect of division of the anterolateral papillary muscle on left ventricular (LV) function and compares two methods of treatment—mitral valve replacement (MVR) and mitral valve repair. Thirteen pigs were placed on cardiopulmonary bypass, and interventions were performed in an isolated beating heart preparation. LV function was assessed with a compliant intraventricular balloon at baseline, after division of the anterolateral papillary muscle (Divided), after repair of the divided papillary muscle (Repair), and finally after MVR. Division of the anterolateral papillary muscle caused a significant deterioration in LV function. Function was maintained at this level after mitral valve repair but deteriorated with MVR. Developed pressure measured at baseline was 179 ± 13 mm Hg; Divided, 148 ± 11 mm Hg (p < 0.05 versus baseline); Repair, 149 ± 15 mm Hg; and MVR, 95 ± 8 mm Hg (p < 0.05 versus Divided) at a balloon volume of 20 ml. These results suggest that LV function is impaired by papillary muscle rupture. Repair of the ruptured papillary muscle is associated with better LV function than is MVR.

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