Introduction: Brucellosis is a common zoonosis in Iran, transmitted to humans by direct contact with infected animal materials like fleece, animal excrement, leather, butchery or by the consumption of contaminated animal products (e.g. fresh cheese, unpasteurized milk or dairy products, and raw meat and raw liver that is consumed semi-roasted by kebab sellers in Iran.Case Presentation: A 21-year-old woman presented with respiratory failure due to pulmonary edema from severe acute mitral valve regurgitation in the setting of acute Brucella endocarditis. She was found to have a RUPTUREd anterolateral PAPILLARY MUSCLE from necrosis caused by corroding large vegetations on the anterior mitral valve leaflet.Conclusions: This occurrence is an exceptionally rare phenomenon, in Brucella mitral endocarditis. Urgent transesophageal echocardiography (TEE) revealed large mobile vegetation on the anterior PAPILLARY MUSCLE with severe mitral valve regurgitation. The patient underwent mitral valve replacement. During valve replacement surgery, anterior mitral valve vegetation and RUPTURE of the AL-PM were confirmed. We also considered that prolonged post-operative antibiotic treatment was indicated in our patient to protect the newly implanted prosthetic valves.

Cardiac injury is a common unexpected injury with high rate of mortality in multi-trauma patients. Blunt thoracic trauma leading to heart injury presented with variable presentations from myocardial contusion to RUPTURE. Cardiac injury is about 15%-25% of blunt chest trauma. Cardiac contusion is the most common type of injury with variable manifestations associated with electrocardiogram (ECG) changes or cardiac enzyme abnormality. Traumatic RUPTURE of intra-cardiac structures after blunt Thoracic trauma is an uncommon. Cardiac valves RUPTURE is uncommon, and the most frequent being aortic valve, and then followed by mitral and tricuspid. Nowadays, the incidence of these types of injury is increasing due to high increase of road traffic accidents (RTA). Following blunt thoracic trauma, RUPTURE of PAPILLARY MUSCLE or its chordae tendineae is a very rare causing acute mitral regurgitation (MR) with sequence of congestive heart failure (HF) and pulmonary edema.

Acute mitral regurgitation accounts for 9% cases of cardiogenic shock following myocardial infarction and results from PAPILLARY MUSCLE infarction. This complication occurs early following myocardial infarction. The etiologies of this devastating complication include left ventricular failure, right ventricular failure and acute mitral regurgitation that mitral regurgitation usually results from PAPILLARY MUSCLE RUPTURE. We reported a 41 year old male with first diagonal branch stenosis and dominant left circumflex and complete transaction of anterolateral PAPILLARY MUSCLE that had not been reported in literature.

PAPILLARY MUSCLE RUPTURE following acute myocardial infarction (AMI), which rarely occurs, leads to catastrophic outcomes.A 56-year-old man with sudden dyspnea and palpitation, one episode syncope, and left sided hemiparesis was admitted to our hospital and diagnosed as type A dissection with extension to the aortic arch and descending aorta. The patient underwent the Benttal and hemiarch procedure.On the 16th postoperative day, he suddenly developed hypotension and respiratory distress. Urgent echocardiography showed severe acute mitral regurgitation due to the RUPTURE of the posteromedial PAPILLARY MUSCLE.Urgent mitral valve replacement was done but unfortunately the patient died two weeks after the second surgery because of sepsis.We propose that during urgent cardiac surgery in a patient with coronary risk factors, concomitant coronary artery bypass graft be performed as thoroughly as possible.

Background: Spontaneous RUPTURE of PAPILLARY MUSCLE from sepsis is extremely rare. Most cases of PAPILLARY MUSCLE RUPTUREs are due to myocardial infarction or trauma. We describe a case of spontaneous acute PAPILLARY MUSCLE RUPTURE in absence of history of ischemic cardiomyopathy or blunt chest trauma.Case Report: A 42 year-old man was transferred to intensive care unit with signs and symptoms of cardiogenic shock. Past history revealed that he had met with a road traffic accident 19 months ago with fracture mid shaft of left femur. He was treated for the same and failed to have regular follow up visits. Physical examination revealed osteomyelitis at the fractured site with sinus formation and pyrexia. His general condition declined thereafter and expired due to cardiac failure few hours later. At autopsy there was RUPTURE of antero-lateral PAPILLARY MUSCLE of mitral valve. Microscopic section of the RUPTUREd PAPILLARY MUSCLE revealed formation of focal abscess with neutrophil infiltration.Conclusion: PAPILLARY MUSCLE RUPTUREs are associated with significantly increased morbidity and mortality. Therefore early diagnosis is very important in providing appropriate treatment. This case emphasized the fact that delay in diagnosis and institution of appropriate antimicrobial therapy for sepsis may result in life threatening complications. Although this occurrence is uncommon, PAPILLARY MUSCLE necrosis and subsequent RUPTURE must be considered as cause of delayed deaths in cases of road traffic accidents with septicemia.

A rare complication of AMI is PAPILLARY MUSCLE RUPTURE (PMR), occurring in 1% of patients with acute myocardial infarction (AMI). Mitral regurgitation related to PMR occurs at a median of 1 day (ranging from 1-14 days) after onset of myocardial infarction. PMR tends to occur in those having a first time AMI and those without extensive collateral circulation. PMR involves posteromedial PAPILLARY MUSCLE and anterolateral PAPILLARY MUSCLE in 75% and 25% of the cases, respectively.We report a 79-year-old man who referred to our hospital with acute severe pulmonary edema. Transthoracic echocardiography showed RUPTUREd anterolateral head of PAPILLARY MUSCLE resulting in flail anterior mitral valve leaflet and acute severe MR. Patient undergone emergent coronary angiography and we found normal epicardial coronary anteries. The patient was emergently transferred to operating room and MV was replaced with a bioprosthetic valve. He was discharged after one week, feeling well.This study proves the significant role of accurate transthoracic echocardiography in determining the mechanism of acute MR and planning for prompt treatment.

Background: RUPTURE of pectoralis major MUSCLE is a very rare and often athletic injury. These days in our country this injury occurs more frequently. This could be due to increase in professional participation of amateur people in different types of sport, like body building and weight-lifting (especially bench-pressing) without adequate preparation, training and taking necessary precautions. In this article, we have tried to review several aspects of complex anatomy of pectoralis major MUSCLE, epidemiology, mechanism, clinical presentations, imaging modalities, surgical indications and techniques of its RUPTURE. Complex and especial anatomy of pectoralis major MUSCLE, in its humeral insertion particularly, have a major role of its vulnerability to sudden and eccentric contraction as the main mechanism of RUPTURE. Also, restoration of this complex anatomy seems to be important during surgical repair to have normal function of the MUSCLE again.

Cardiac hydatid cyst is an uncommon lesion, mostly caused by Echinococcus granulosus. Humans are infected by contaminated dogs during their childhood or contaminated uncooked vegetables in sheep-raising areas of the world such as South America, Australia, New Zealand, Philippines, China, Arabia, Eastern Europe, and the Mediterranean coast. We report a case of hydatid cyst in the PAPILLARY MUSCLE of the tricuspid valve. To the best of our knowledge, hydatid cyst in the PAPILLARY MUSCLEs has not been reported and the present case is the first case reported.

Introduction: The understanding of gross cardiac anatomy has been relatively stable over the last 80 years, reliant on well-established autopsy findings. The advent of dynamic imaging by cardiac MRI and CT provides a window to view anatomic features in vivo, providing insights typically masked at autopsy due to death. Hypothesis: We hypothesize that cardiac magnetic resonance (CMR) with its high spatial and temporal resolution allows detection of anatomic features not previously appreciated at autopsy. Methods: Two hundred fifty-five sequential, CMR examinations were retrospectively examined to describe the anatomic features of the LV (left ventricular) PM (PAPILLARY MUSCLEs). Specifically, the origin of the base of the PM was delineated. The insertion of the PM was seen in 255/255 patients. Results: In 249 out of 255 patients (97. 6%), the appearance of the PM was not a uniform MUSCLE arising from the inner face of the LV myocardium, but was a finger-like series of long, slender trabeculae carneae traversing >1 cm before inserting into the main body of PM challenging our previous understanding of PM anatomy. Conclusion: The capabilities of dynamic CMR to view cardiac features in vivo non-invasively provides a useful tool to study cardiac anatomy. Unlike the widely accepted representation of PAPILLARY MUSCLEs, uniformly arising from the floor of the LV, the base resolves into a ‘ cypress-tree’ root-like structure with multiple thin projections before coalescing into a thick MUSCLE head. Such observations have far reaching clinical implications in areas such as mitral regurgitation, post-MI remodeling and electrical transmission of the His-Purkinje system, and further work is indicated to delineate the role of non-invasive imaging in these areas.

Background: The aim of this study was to assess the isokinetic measures of surgically repaired RUPTUREs of the pectoralis major MUSCLE in contrast to non-injured side of the patients and specify the most affected movement of the injured side.Methods: Nine pectoralis major MUSCLE tears in nine patients were studied. They were all operated by the same surgeon and after 2.4 years (1-4 years) of follow up they were clinically examined. They completed a standard questionair and isokinetic dynamometry were carried out bilaterally. There was also a group of six non-injured bodybuilders who were assessed by isokinetic dynamometry to give us normal differences in the values of both limbs.Results: In the patient group, the mean torque of flexion was not different between the injured and uninjured sides (p≥.05). For the extension movements, the difference was significant (p<.034) but for the other movements was not. None of the results fell into the excellent or poor categories according to Kakwani classification. Six patients were categorized as good and three patients as fair. The main reason for the three “fair” patients was cosmetic complaints in the cases who were operated on three months post injury.Conclusions: The surgical repair of RUPTUREd pectoralis major is beneficial and focusing on strengthening exercises for flexion and extension is essential to achieve the best results.