A Clinicopathological Study on the Papillary Muscle Dysfunction

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Abstract
A total of 11 cases of papillary muscle dysfunction (PMD) was found among 600 consecutive autopsies (1.8%). There were men and 6 women (ranging from 64-92 yr). Auscultation and phonocardiograms revealed holosystolic murmurs in 9 cases and early systolic murmurs in 2. There were accentuated 1st sounds in 8 cases, 3rd sounds in 7 and 4th sound in 5. PMD was classifed into 3 types according to the clinical course and pathologic examinations. In type A (6 cases) myocardial infarction (MI) preceded the occurrence of mitral regurgitation (MR) by 3 or 4 yr, with pathological verification of old MI. In type B (1 case) Mr developed during acute MI. In type C (4 cases) patholgoical examinations disclosed various degrees of myocardial fibrosis, in which clinical diagnosis was MR of unknown etiology. In a total of 113 cases of MI 36 cases (32%) showed papillary muscle infarction (PMI), which occurred with a significantly high incidence of large MI and subendocardial of lateral MI in males. Among 36 cases of PMI 9 cases developed PMD, which showed a high incidence in females. PMI and severe lesions in the corresponding ventricular wall were both necessary for the development of PMD.

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