RUPTURE VENTRICULAR PAPILLARY MUSCLE DURING ACUTE MYOCARDIAL INFARCTION

某些临床和心脏形态学发现描述于22 患者，年龄45 - 80岁（平均64岁）（15名男性[68%]），其中 急性心肌梗死时出现乳头肌。 在大多数情况下， 急性心肌梗死合并乳头肌破裂 是他们的第一次冠状动脉事件（只有18%的心肌疤痕符合 有既往梗死史，29%有心绞痛）。 后内侧 乳头肌，可能是因为它的血液供应更脆弱， 破裂的频率几乎是前外侧的3倍（73%， 27%）。 狭窄量的定量检查 4个主要心外膜冠状动脉中的动脉粥样硬化斑块 动脉（右、左主干、左前降支和左回旋支） 显示破裂患者的狭窄程度低于 与破裂无关的致死性急性心肌梗死。 在519人中 5 mm的冠状动脉切片检查（11例患者），仅68例（13%） 与34%的患者相比， 来自27例致死性心肌梗死患者的1403张切片， 破裂

Certain clinical and cardiac morphologic findings are described in 22 patients, aged 45 to 80 years (mean 64) (15 men [68%]), in whom rupture of a papillary muscle occurred during acute myocardial infarction. In most, the acute myocardial infarction associated with papillary muscle rupture was their first coronary event (only 18% had myocardial scars consistent with prior infarction and 29% had angina pectoris). The posteromedial papillary muscle, presumably because of its more tenuous blood supply, ruptured almost 3 times more frequently than the anterolateral one (73% and 27%, respectively). Quantitative examination of the amounts of narrowing by atherosclerotic plaque in each of the 4 major epicardial coronary arteries (right, left main, left anterior descending and left circumflex) disclosed less narrowing in the rupture patients than in patients with fatal acute myocardial infarction unassociated with rupture. Of the 519 five-mm sections of coronary artery examined (11 patients), only 68 (13%) were narrowed greater than 75% in cross-sectional area compared to 34% of 1403 sections from 27 patients with fatal myocardial infarction without rupture.