[Acute pulmonary edema due to dysfunction and/or rupture of the papillary muscles in patients with coronary insufficiency. Surgical results].

Acute mitral regurgitation due to severe papillary muscle dysfunction or rupture has a poor clinical outcome and often requires an emergency surgical procedure. Pulmonary venous congestion generally occurs as an end-stage event and in these patients surgery is often postponed or even not considered. We studied 14 consecutive patients with coronary artery disease that suffered acute pulmonary edema soon after mitral regurgitation was diagnosed; they were 8 (57%) male and 6 (43%) female with mean age 60-8 years (49 to 69 years). Five patients had an acute myocardial infarction and 9 had an old infarction or stable angina. Surgical treatment was indicated to all patients: mitral valve replacement or reconstructive procedure (annuloplasty) was the only procedure in 2 patients and was associated to coronary artery revascularization in the other 12. Two patients (14.3%) with acute myocardial infarction died in hospital; the remaining 12 (85.7%) had hospital discharge and did well in the late follow-up period. We concluded that this high-risk group of patients is particularly suitable for surgical management since medical treatment carries a very poor prognosis.