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Revisão da ruptura de músculo papilar da válvula mitral pós-enfarte agudo do miocárdio : a propósito de um caso clínico
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Resumo(s)
A ruptura de um músculo papilar complica 1 a 3% dos Enfartes Agudos do Miocárdio, representando 5% das mortes relacionadas com esta entidade clínica, sendo a ruptura do músculo papilar posteromedial da válvula mitral 6 a 12 vezes mais frequente do que a ruptura do músculo papilar anterolateral. Esta complicação mecânica do Enfarte Agudo do Miocárdio leva ao prolapso da válvula mitral com consequente insuficiência mitral aguda. O diagnóstico baseia-se no ecocardiograma, estando detalhada no presente trabalho a comparação entre o ecocardiograma transtorácico e o transesofágico. A terapêutica é também abordada, podendo passar pela reparação da válvula mitral até a sua substituição. É discutido um caso clínico de uma ruptura de músculo papilar posteromedial no contexto de um Enfarte Agudo do Miocárdio, num doente de 76 anos.
The rupture of a papillary muscle occurs in 1 to 3% of Acute Myocardial Infarction, accounting for up to 5% of death related to this clinical entity. The rupture of the posteromedial papillary muscle of the mitral valve is 6 to 12 times more frequent than the rupture of the anterolateral papillary muscle. This mechanical complication of the Acute Myocardial Infarction leads to the prolapse of the mitral valve with subsequent acute mitral regurgitation. The diagnosis is based on the echocardiogram, being detailed in the present paper the comparison between the transthoracic and the transesophageal echocardiograms. The therapeutics is also reviewed and can mean reparation of the valve up to its entire replacement. It is reported a case of a posteromedial papillary muscle rupture decurring form an Acute Myocardial Infarction in a 76 year old male patient.
The rupture of a papillary muscle occurs in 1 to 3% of Acute Myocardial Infarction, accounting for up to 5% of death related to this clinical entity. The rupture of the posteromedial papillary muscle of the mitral valve is 6 to 12 times more frequent than the rupture of the anterolateral papillary muscle. This mechanical complication of the Acute Myocardial Infarction leads to the prolapse of the mitral valve with subsequent acute mitral regurgitation. The diagnosis is based on the echocardiogram, being detailed in the present paper the comparison between the transthoracic and the transesophageal echocardiograms. The therapeutics is also reviewed and can mean reparation of the valve up to its entire replacement. It is reported a case of a posteromedial papillary muscle rupture decurring form an Acute Myocardial Infarction in a 76 year old male patient.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Válvula mitral Enfarto do miocárdio Cardiologia