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Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report

BACKGROUND: Acute heart failure caused by severe mitral regurgitation (MR) due to papillary muscle rupture has been described in the puerperium by case reports; however, the majority of cases of papillary muscle rupture are caused by myocardial infarction. We describe papillary muscle rupture occurr...

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Autores principales: Curtis, Elizabeth, Corkill, Michael, Amir, Nezar, Haydock, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026610/
https://www.ncbi.nlm.nih.gov/pubmed/32099964
http://dx.doi.org/10.1093/ehjcr/ytz163
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author Curtis, Elizabeth
Corkill, Michael
Amir, Nezar
Haydock, David
author_facet Curtis, Elizabeth
Corkill, Michael
Amir, Nezar
Haydock, David
author_sort Curtis, Elizabeth
collection PubMed
description BACKGROUND: Acute heart failure caused by severe mitral regurgitation (MR) due to papillary muscle rupture has been described in the puerperium by case reports; however, the majority of cases of papillary muscle rupture are caused by myocardial infarction. We describe papillary muscle rupture occurring in the postpartum period in a patient with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), and chronic Libman–Sacks endocarditis and explore the multifactorial nature of the papillary muscle infarction and rupture in the setting of postpartum fluid shifts, chronic myocardial injury from Libman–Sacks, and high thrombotic risk. CASE SUMMARY: A 29-year-old woman presented with acute heart failure 2 weeks’ postpartum and was found to have acute MR due to a flail leaflet caused by papillary muscle rupture. She proceeded to emergency surgery with mitral valve (MV) replacement and the histology revealed evidence of chronic Libman–Sacks endocarditis and papillary muscle infarction with thrombi in the intramyocardial arteries. DISCUSSION: This is the second case report of papillary muscle rupture in the puerperium in a patient with SLE in the literature, the other case was caused by catastrophic APLS. However, in this case, the cause of the rupture is likely to be multifactorial; as a consequence of thrombosis in the microvasculature causing isolated papillary muscle ischaemia, and fibrosis of the muscle due to chronic Libman–Sacks endocarditis resulting in limited pliability which caused rupture of the papillary muscle when faced with the added stress of increased volume that occurs in the puerperium.
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spelling pubmed-70266102020-02-25 Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report Curtis, Elizabeth Corkill, Michael Amir, Nezar Haydock, David Eur Heart J Case Rep Case Reports BACKGROUND: Acute heart failure caused by severe mitral regurgitation (MR) due to papillary muscle rupture has been described in the puerperium by case reports; however, the majority of cases of papillary muscle rupture are caused by myocardial infarction. We describe papillary muscle rupture occurring in the postpartum period in a patient with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), and chronic Libman–Sacks endocarditis and explore the multifactorial nature of the papillary muscle infarction and rupture in the setting of postpartum fluid shifts, chronic myocardial injury from Libman–Sacks, and high thrombotic risk. CASE SUMMARY: A 29-year-old woman presented with acute heart failure 2 weeks’ postpartum and was found to have acute MR due to a flail leaflet caused by papillary muscle rupture. She proceeded to emergency surgery with mitral valve (MV) replacement and the histology revealed evidence of chronic Libman–Sacks endocarditis and papillary muscle infarction with thrombi in the intramyocardial arteries. DISCUSSION: This is the second case report of papillary muscle rupture in the puerperium in a patient with SLE in the literature, the other case was caused by catastrophic APLS. However, in this case, the cause of the rupture is likely to be multifactorial; as a consequence of thrombosis in the microvasculature causing isolated papillary muscle ischaemia, and fibrosis of the muscle due to chronic Libman–Sacks endocarditis resulting in limited pliability which caused rupture of the papillary muscle when faced with the added stress of increased volume that occurs in the puerperium. Oxford University Press 2019-11-13 /pmc/articles/PMC7026610/ /pubmed/32099964 http://dx.doi.org/10.1093/ehjcr/ytz163 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Reports
Curtis, Elizabeth
Corkill, Michael
Amir, Nezar
Haydock, David
Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
title Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
title_full Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
title_fullStr Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
title_full_unstemmed Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
title_short Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
title_sort acute papillary muscle infarction and rupture in the puerperium complicating libman–sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026610/
https://www.ncbi.nlm.nih.gov/pubmed/32099964
http://dx.doi.org/10.1093/ehjcr/ytz163
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