THE report by Burch et al in 19631 of papillary muscle dysfunction causing mitral insufficiency described a new mechanism for mitral insufficiency developing as a secondary complication of coronary artery disease. The syndrome of mitral insufficiency resulting from rupture of chordae tendineae2-4 is well recognized, but the entity of serious mitral insufficiency resulting from intact but malfunctioning papillary muscles is new. The characteristics of this syndrome, indications for an operation, and contraindications to an operation are all yet undefined. The report by Fluck et al in November 1966 of a successful operation upon one patient with mitral insufficiency from malfunctioning papillary muscles may represent the first report of such a patient being treated surgically.5 This report describes surgical experiences with four patients in whom mitral insufficiency developed as a secondary complication of occlusive disease of the coronary arteries.
Report of Cases
—A 59-year-old man was