Papillary Muscle Rupture after Benttal Operation : Is It Necessary to Do CABG in High-Risk Patients?

Papillary muscle rupture following acute myocardial infarction (AMI), which rarely occurs, leads to catastrophic outcomes. A 56-year-old man with sudden dyspnea and palpitation, one episode syncope, and left sided hemiparesis was admitted to our hospital and diagnosed as type A dissection with extension to the aortic arch and descending aorta. The patient underwent the Benttal and hemiarch procedure. On the 16th postoperative day, he suddenly developed hypotension and respiratory distress. Urgent echocardiography showed severe acute mitral regurgitation due to the rupture of the posteromedial papillary muscle. Urgent mitral valve replacement was done but unfortunately the patient died two weeks after the second surgery because of sepsis. We propose that during urgent cardiac surgery in a patient with coronary risk factors, concomitant coronary artery bypass graft be performed as thoroughly as possible