Subacute papillary muscle rupture following percutaneous mitral valvuloplasty

Introduction Mitral valve stenosis is becoming increasingly rare in industrialized countries thanks to the almost complete extinction of rheumatic valve disease. Nevertheless, every cardiologist will encounter a few cases, notably in elderly with degenerated calcified mitral valves or in younger immigrants coming from parts of the world with endemic rheumatic valve disease. Patients usually present with progressive dyspnoea due to increased left atrial and pulmonary artery pressures and a decline in cardiac output secondary to preload reduction. Introduced by Inoue in 1984, percutaneous balloon mitral valvuloplasty constitutes an elegant treatment modality in patients with appropriate valvular anatomy, with excellent immediate results and long-term outcome. The original Inoue technique, based on the surgically closed commissurotomy, employs the eponymous balloon to crack the mitral commissures to separate the mitral leaflets along their natural plane thereby enlarging the mitral valve area. Similar but slightly different techniques have emerged throughout the years and have extensively been used in the clinic. One of them is the so-called double balloon valvuloplasty, first described in Saoudi Arabia by Al-Zaibag, during which two balloons are positioned side-by-side across the stenotic valve and inflated simultaneously. Mitral regurgita-tion is relatively common after balloon dilatation, but is mostly mild and caused by excessive commissural tearing or slight prolapse of the anterior leaflet1. We present a rare case of severe mitral regurgitation following double balloon mitral valvuloplasty due to papillary muscle rupture.