[A case of emergency surgery for acute mitral regurgitation due to complete papillary muscle rupture as a severe form of reperfusion injury: report of a case].

Complete rupture of a papillary muscle following acute myocardial infarction is a severe complication associate with acute left ventricular failure and pulmonary edema. Since the introduction of acute percutaneous transluminal coronary angioplasty (PTCA) in the management of acute myocardial infarction, the frequency of this complication has further decreased. We described a patient who had acute mitral regurgitation due to complete rupture of papillary muscle rupture after successful coronary intervention. Transesophageal echocardiography demonstrated severe mitral regurgitation and the ruptured papillary muscle. At operation, posteriol papillary muscle was found to be totally ruptured. Mitral valve replacement was performed. Postoperative course was uneventful, with 2 days of IABP and 5 days of ventilator support.

Thromboembolic complication in atrial fibrillation in a long-term follow-up--the relationship with underlying disease, type of atrial fibrillation, and antithrombotic therapy.

The incidence of thromboembolic complications among 288 patients with atrial fibrillation (AF) who were followed up during an average period of 7.2 years was examined retrospectively. The annual incidence of thromboembolic complications was 1.6% in total, 1.7% in valvular heart disease (n=128), and 2.1% in non-valvular heart disease (n=117). No thromboembolism occurred in lone AF (n=43), defined as the complete absence of any underlying disease. The type of AF before embolic attack was chronic in 26 cases and paroxysmal in 6 cases. The cardiac rhythm at the time of the embolic attack was AF, except in 2 cases in which ECG was not recorded. In all patients with thromboembolic complications who were receiving antithrombotic therapy during the follow-up, the anticoagulant effect just before the embolic attack was found to be insufficient. Major bleeding was not observed in the patients receiving antithrombotic therapy. Thromboembolism in AF in long-term follow-up tends to occur more frequently in patients with underlying heart disease and in those with chronic AF compared rather than paroxysmal AF; it rarely occurs in lone AF. We should not hesitate to administer sufficient anticoagulant therapy in AF patients who are at high risk of developing thromboembolic complications.