TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN CARDI OGENIC-SHOCK DUE TO INFERIOR MYOCARDIAL-INFARCTION WITH PAPILLARY-MUSCLE RUPTURE

A 63-year-old male patient suffered an acute myocardial infarction ent irely confined to the posterior wall. As symptoms persisted and cardio genic shock developed immediate heart catheterization was performed, w hich demonstrated an occlusion of the left circumflex branch. Right-he art catheterization demonstrated an enlarged v-wave. Thus, acute infar ct associated mitral regurgitation was suspected. In the catheterizati on laboratory transesophageal echocardiography including Doppler- and contrast echocardiography was then performed, which revealed the diagn osis of posterior papillary muscle rupture. The patient proceeded imme diately to emergency surgery during which mitral valve replacement wit h a St. Jude prothesis was performed in addition to venous bypass reva scularization of the occluded and a further stenosed coronary artery. The postoperative follow-up was without any complications and the pati ent recovered satisfactorily from the acute event. This case demonstra tes the excellent diagnostic utility of emergency transesophageal echo cardiography in the situation of infarct related myocardial rupture, w hich has to precede the life-saving operation.