• Journal of Trauma and Injury
• /
• v.34 no.2
• /
• pp.136-140
• /
• 2021

We present a case of delayed diagnosis of traumatic tricuspid valve rupture in a patient who was emergently brought to the operating room for repair of lacerations to the heart and liver without intraoperative transesophageal echocardiography (TEE). Initial postoperative transthoracic echocardiography (TTE) did not show structural pathology. One week later, TTE with better image quality showed severe tricuspid regurgitation. Subsequently, TEE clearly demonstrated rupture of the anterior papillary muscle and flail anterior tricuspid leaflet. The case description is followed by a brief discussion of the utility of TEE in the setting of blunt thoracic trauma.

• Journal of Chest Surgery
• /
• v.40 no.11
• /
• pp.770-772
• /
• 2007

Papillary fibroelastoma is a rare benign tumor of the heart. A 21-year-old man presented with dyspnea on exertion and echocardiogram showed a small round mass attached to the anterolateral papillary muscle. After excision of the mass, including anterior papillary muscle, chordae tendinae, and anterior leaflet, he underwent mitral valve re-placement with a mechanical valve. He was discharged on anticoagulant therapy without further problems.

• The Korean Journal of Physiology
• /
• v.16 no.1
• /
• pp.13-23
• /
• 1982

Effects of external pH and potassium concentrations on the electrical and mechanical properties were investigated on rabbit papillary muscle. Papillary muscles were perfused in horizontal chamber with Tris Tyrode solutions and action potential along with isometric tension was recorded simultaneously. Potassium concentrations were varied between 1 and 12 mM at low(6.9), normal(7.4) and high (7.9) external pH. The following results were obtained: 1) On rasing the potassium concentration from 1 to 12 mM resting membrane potentials decreased from $-88.8{\pm}2.8$ to $-66.4{\pm}1.2\;mV$ at normal pH and the amplitude of action potential decreased from $115.1{\pm}0.7$ to $97.5{\pm}2.8\;mV$. On lowering the potassium concentration, membrane hyperpolarized and at 1 mM potassium concentration resting potentials were $-107{\pm}2.2\;mV$. Duration of action potential especially $APD_{60}{\sim}APD_{90}$ increased($APD_{90}$: $214{\pm}15.8\;ms$ at 1 mM $K^+$ to $287{\pm}18.1\;ms$ at 12 mM $K^+$). 2) During acidosis membranes hyperpolarized by more than 20 mV within 1 min. and then slow recovery was observed during the following 10 min. During alkalosis membranes depolarized about 10 mV, which were maintained until washing with normal Tyrode solutions. 3) On lowering the external pH(7.9-6.5), duration of action potential increased progressively and it was most prominent at pH 6.5 and $K^+$ 1mM. 4) Magnitude of developed tension was $0.6{\pm}0.14\;g/mm^2$ at normal pH and potassium concentration (stimulus frequency : 60/min). Relative isometric tension to normal value increased along the increment of stimulus frequency($44.2{\pm}4.2%$ at 6/min to $271{\pm}86.7%$ at 180/min). Force-frequency relations were altered quantitatively during the perfusion with different external pH solutions. 5) Developed tension did not show marked variation within the range of $2{\sim}8\;mM$ potassium concentrations. Positive inotropism was observed at less than 2 mM $K^+$ and negative inotropism beyond 12 mM $K^+$ concentrations. From the above results we concluded that the effects of potassium ion concentration on electrical and mechanical properties of rabbit papillary muscle are related to the changes in surface negative charge due to acid base disturbances.

• Journal of Chest Surgery
• /
• v.25 no.11
• /
• pp.1254-1260
• /
• 1992

Rupture of the posterior left ventricular wall following mitral valve replacement is a rare but fatal complication. Over a 10 year period from August 25 1980 to November 27 1990, we have experienced 6 such patients among 884 cases of mitral valve replacement with 4 deaths and 2 survivors. One patient had a type I rupture and another a type II rapture with the remaining four patients having suffered type III ruptures. All of the ruptures were dis covered intraoperatively enabling prompt reinstitution of the cardiopulmonary bypass and subsequent cardioplegic arrest prior to repair. Overzealous removal of calcified valve leaflets seemed to be responsible for the single type I rupture, and untethering of the so called ventricular loop appeared to be the main mechanism responsible for the type III ruptures. The single type II rupture that had occurred seemed to have been caused by inadvertent laceration of the papillary muscle with resultant rupture of the posterior LV wall at the base of the papillary muscle. Among the type III ruptures, 2 patients required intraaortic balloon pump[IABP] support only for mechanical assistance and 1 patient required both the IABP and the Biomedicus LV assist device for successfull weaning following repair of the LV rupture Another patient with a type II rupture also required the circulatory assistance of both the IABP and the bio-medicus LV assist device for weaning from the bypass. Attention to meticulous technical considerations such as avoiding over aggressive removal of heavily calcified valvular tissue, preservation of as much mural leaflet tissue and chordal stuctures as possible seemed helpful in preventing this catastrophic complication from occurring. Fusion and fibrous stricture of the chordal structures appeared particularly conducive to the type II ruptures as a result of the increased susceptibility to papillary injury during operation.

• Journal of Chest Surgery
• /
• v.30 no.5
• /
• pp.533-536
• /
• 1997

We report a successful repair of severe traumatic tricuspid regurgitation by PTFE chordal replacement and ring annuloplasty. A 64-year-old man with multiple trauma was referred to our department because of cardiomegaly on chest roentgenogram. Echocardiography showed moderate amount of pericardial effusion and severe tricuspid regurgitation with rupture of anterior papillary muscle. But he experienced progressive dyspnea, and chest roentgenogram showed pro ressive cardiomegaly. He underwent operation 4 months after trauma. The nterior papillary muscle was reinserted, and the valve was repaired by PTFE chordal replacements and ring annuloplasty. Postoperatively, the patient's functional status was improved, and there was trivial tricuspid regurgitation on echocardiographic examination.

• Journal of Chest Surgery
• /
• v.30 no.9
• /
• pp.927-931
• /
• 1997

Tricuspid regurgitation due to rupture of a chorda is a rare disease in newborns. Recently, we experienced one day old male with tricuspid regurgitation due to rupture of a chorda of anterior papillary muscle, and who had suffered from severe hypoxemia, acidosis, cyanosis, and bradycardia. Preoperative diagnosis was pulmonary atresia with intact ventricular s ptum, massive tricuspid regurgitation, and patent ductus arteriosus by echocardiogram, which demonstrated no flow through the pulmonic valve. At operation, the pulmonic valve was intact and a chorda of anterior papillary muscle was ruptured. Tricuspid regurgitation was corrected successfully with reconstruction of the chords. Postoperative course was complicated by pneumonia and sepsis, but the infant recovered and discharged at postoperative 20 days.

• Journal of Chest Surgery
• /
• v.16 no.3
• /
• pp.272-280
• /
• 1983

With respect to controversial opinions concerning the nitroglycerin effects on cardiac muscle the direct nitroglycerin actions were thoroughly studied in isolated papillary muscles, atrial preparations and coronary strips of rabbits. Isometric active tension of papillary muscles developed at $35^{\circ}C$ upon electric stimulation at a rate of 60/min, was not affected by nitroglycerin up to a concentration of 10mg/L Higher concentrations of nitroglycerin, however, reduced action tension progressively. This depression of mechanical activity is accompanied by a decrease in oxygen consumption as measured by means of a flow respirometer. Resting oxygen uptake, on the other hand, remained unchanged. Similarly active tension of spontaneously beating atrial preparations also declined at a nitroglycerin concentration of more than 10 mg/L, whereas the sinus frequency did not change up to 40 mg/L. In contrast, rabbit coronary strips are much more sensitive to nitroglycerin and relax in a range of 10-100 ug/L of nitroglycerin concentration. The results indicate that the pharmacologic effects of nitroglycerin in coronary disease are due to vascular actions, because the plasma levels of nitroglycerin attainable in human therapy are not sufficiently high to directly influence the myocardium.

• Korean Journal of Veterinary Research
• /
• v.26 no.2
• /
• pp.195-199
• /
• 1986

The papillary tubercles (PTs) developed on the splenic capsule of normal Landrace pigs were collected and their histological structures were observed with light microscope. The results were summarized as follows : 1. The external features of the PTs were smooth spherical or oval form protruded on the splenic capsules. On cross section of PTs, the shapes were predominantly round or elliptical single follicular form, and were often multifollicular and irregular form in some PTs. 2. The PTs were interposed into the splenic capsule. Therefore the peripheral boundary of PT was consisted of splenic capsular tissue and this tissue was covered with mesothelium, The basal tissues of PT were consisted of thick connective tissue and smooth muscle of splenic capsule, and capsular foramen for transport tract between splenic parenchyma and the PT was found at the center of the basal boundary of PT. 3. The basal region of PT was composed of parenchyma and this tissue was the splenic red pulp but the central and peripheral regions of PT contained much more erythrocytes than in the splenic parenchymae. 4. The splenic parenchymae adjoining to PT contained more erythrocytes than in other splenic parenchymal regions and parallel fixed cells directed to the capsular foramen.

• Journal of Chest Surgery
• /
• v.37 no.5
• /
• pp.401-409
• /
• 2004

Background: As the rupture of chordae and/or papillary muscle became the main cause of mitral valve regurgitation, mitral reconstructive surgery has a very important role. In this regard, we analyzed the clinical result and postoperative early result of operative treatment performed in our hospital, Material and Method: For this analysis, forty nine patients (male 26, female 23, mean age 49.0$\pm$16.5) who underwent mitral valve operation caused by the rupture of chordae and/or papillary muscle from August 1991 to April 2002 were reviewed. Among forty nine patients, twenty two (44.9%) received mital valve reconstruction and twenty seven (59.2%) received mitral valve replacement. Result: As to the pathological etiology of rupture of mitral and papillary muscle, twenty five cases (51.0%) were nonspecific degeneration, eleven cases (22.4%) were myxomatous degeneration, seven cases (14.3%) were subacute bacterial endocarditis. Three patients suffered mortality after operation (6.1%) and valve replacement was performed again on one patient because of remnant mitral insufficiency after valve reconstruction. The 5-year survival rate after operation for the entire mitral valve regurgitation patients was 81 .4%. We have also compared and analyzed the operation results of a group of patients who underwent valve reconstruction and the other group of patients who underwent valve replacement from thirty six patients who had suffered from mitral valve regurgitation caused by degenerative disease. The mortalities were 0% and 14.3%, respectively and the 5-year survival rates were 90.2% and 64.3%, respectively, but there were no statistical significance. Conclusion: The most common pathological etiology of mitral valve regurgitation caused by rupture of chordae and/or papillary muscle was nonspecific degeneration, In case of degenerative disease is the cause of mitral valve regurgitation, valve reconstruction showed better long-term effects in many respects and better operation results compared to valve replacement.

• The Korean Journal of Physiology
• /
• v.14 no.2
• /
• pp.7-16
• /
• 1980

The effects of various inotropic interventions on the shape of the steady state length tension relation and the length-dependent activation process in cardiac muscle were studied. The influence of inotropic interventions upon the action potential was also observed. The range of varying muscle length was from the optimal length$(l_{max})$, where the active tension production is maximal, to 0.85 $l_{max}$. Changes in stimulus frequency or in external bathing Ca concentration constituted the inotropic interventions in this experiment. The papillary muscles were isolated from the rabbit right ventricles and perfused with $HCO-_3\;-buffered$ normal Tyrode solution which was aerated with $3%\;CO_2-97%\;O_2$ mixed gas and kept at $35^{\circ}C$. Resting Passive tension at $l_{max}$ was approximately 30% of the total tension and appeared from the muscle length of 0.90 $l_{max}$. The effect of stimulus frequency on the steady state level of developed tension was: As the stimulus frequency was increased from 0.1 to 0.5 Hz, there was little change in developed tension. As the frequency was increased further, to a value of about 3 Hz, tension increased steeply. Further increase of the frequency to 5 Hz had little additional effect on the developed tension. The length-tension curves for isometric peak tension became more steeper with the degree of potentiation by inotropic interventions. The relative steepness of the normalized length-tension curves where tension production was expressed as a percentage of maximal tension developed at $l_{max}$, varied inversely with the level of inotropic state and these curves were not superimposable one another. Thus at the stimulus frequency of 2 Hz or at the external Ca concentration of 8 mM, the relative decline in the developed tension for a given change in muscle length was considerably less than the decline observed at the frequency of 0.5 Hz or at the concentration of 2 mM Ca. Action potential duration was prolonged significantly as the frequency increased from 0.2 to 2 Hz, and this change in action potential duration was not observable on the changes in muscle length. There was a tendency of the hyperpolarization of membrane potential when the muscle length was shortened from $l_{max}$ to 0.95 $l_{max}$. These results support the hypothesis that there is a length-dependence of the activation process.