Postinfarct Intracardiac Mass with Severe Mitral Regurgitation: Late Rupture of One of the Heads of Posteriomedial Papillary Muscle

Acute ischemic mitral regurgitation is due to complete or partial rupture of either anterolateral or posteriomedial papillary muscles occurring within a week of acute myocardial infarction. Chronic ischemic mitral regurgitation is due to postinfarct remodeling leading to imbalance between tethering and closing forces of mitral valve apparatus. We present a 64-year-old male, presenting with acute pulmonary edema secondary to severe mitral regurgitation, a week after his myocardial infarction. Transthoracic echocardiogram detected a mobile intracardiac mass near anterior mitral leaflet with no clear-cut intracardiac origin of this mass. Perioperative transesophageal echocardiography detected rupture of one of the heads of posteriomedial papillary muscle. This case illustrates a rare presentation of postinfarct rupture of one of the heads of posteriomedial papillary muscle occurring late after infarction presenting as an intracardiac mass, which can have surgical