ABSTRACT
Papillary muscle rupture is a rare, life-threatening post myocardial infarction mechanical complication. Without surgical intervention, prognosis is very poor. Clinicians need to recognize this complication early, as prompt therapy is crucial. We present a case of inferior ST elevation myocardial infarction complicated by posteromedial papillary muscle rupture resulting in severe acute mitral regurgitation (flail anterior mitral leaflet), acute pulmonary edema and cardiogenic shock. In our patient, a new mitral regurgitation murmur suggested this mechanical complication. Complete disruption of papillary muscle was visualized by transesophageal echocardiography. This case illustrates the importance of good physical examination for early diagnosis of papillary muscle rupture, so that life-saving treatment can be administered without delay.
Subject(s)
Bioprosthesis , Coronary Artery Bypass/methods , Heart Rupture, Post-Infarction , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Inferior Wall Myocardial Infarction , Mitral Valve Insufficiency , Papillary Muscles , Aged , Coronary Angiography/methods , Early Diagnosis , Echocardiography, Transesophageal/methods , Heart Rupture, Post-Infarction/complications , Heart Rupture, Post-Infarction/diagnosis , Heart Rupture, Post-Infarction/physiopathology , Humans , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/physiopathology , Male , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Papillary Muscles/diagnostic imaging , Papillary Muscles/injuries , Physical Examination/methods , Severity of Illness Index , Treatment OutcomeABSTRACT
Trans-catheter aortic valve replacement (TAVR) was approved by the U.S. Food and Drug Administration in 2012 for treatment of severe symptomatic aortic stenosis in non-surgical and high risk patients. Implementation of this complex procedure requires a comprehensive heart team approach. Rural demographics in the Midwest pose many challenges related to low volumes of operations both at institutional and individual levels, leading to serious concerns about the quality of care delivered in such a setting. We compared the TAVR data at the University of South Dakota Sanford Medical Center to the national registry with the aim of looking at differences in outcomes of this procedure in a rural setting.
Subject(s)
Aortic Valve Stenosis/surgery , Rural Population , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Female , Humans , Male , Patient Care Team , Program Evaluation , South Dakota , Treatment OutcomeABSTRACT
Surgical resection remains the best treatment option for patients with limited stage non-small cell lung cancer (NSCLC). Stage I and Stage II lung cancer, where there is no lymph node involvement or the involvement is limited to the peribronchial and hilar lymph nodes (NI), can be completely resected with good five-year survival rates (50 to 90 percent). Controversy remains regarding surgery's role in treating more regionally advanced lung cancers involving mediastinal or subcarinal nodes (N2). These tumors (Stage IIIA) have poor survival with surgery, and there has been an advancing role for chemotherapy and/or radiation in their treatment. Surgery is rarely indicated in Stage IIIB or IV lung cancer.
