Editorial
The case for an aggressive surgical approach to papillary muscle rupture following myocardial infarction: "From paradise lost to paradise regained"
| The first 150 words of the full text of this article appear below. |
"Diseases desperate grown by desperate appliances will be relieved or not at all" (Shakespeare, Hamlet IV 8-10)
The mortality of patients who develop cardiogenic shock
following myocardial infarction remains high, despite modern management with medical and interventional treatment.1 Although an
invasive approach to revascularisation may have a favourable impact
upon mortality in comparison to medical treatment alone, the 30 day mortality of the aggressively treated patients in the SHOCK (should we
emergently revascularize occluded coronaries for cardiogenic shock)
trial was a discouraging 47%.2 The majority of patients who develop cardiogenic shock have severe left ventricular systolic dysfunction as a consequence of large regions of infarcted or ischaemic
myocardium, which underlies a clinical course characterised by
progressive haemodynamic deterioration. In contrast, acute haemodynamic
deterioration may also result from rupture of the left ventricular free
wall, ventricular septum, and papillary muscles. Free wall rupture is
by far the most common of all ruptures
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