Mitral Valve Posteromedial Papillary Muscle Head Rupture Presenting After Liposomal Doxorubicin Chemotherapy for Metastatic Lung Liposarcoma: A Case Report

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ID: 322969
2026
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Abstract
Abstract Background Doxorubicin-induced cardiotoxicity classically manifests as dose-dependent left ventricular systolic dysfunction. Herein, we describe an unusual case of acute mitral papillary muscle rupture following cumulative anthracycline therapy, presenting despite a preserved ejection fraction. Case Summary A 78-year-old woman with metastatic liposarcoma and multiple cardiovascular risk factors developed acute dyspnea one week after completing liposomal doxorubicin (cumulative absolute dose 534 mg). She previously received 5-fraction stereotactic body radiation therapy (SBRT) to the lower lung lobes in September 2024 (9 months prior), targeting fields in close geographic proximity to the diaphragmatic and inferior heart walls. Surveillance echocardiograms from 2022 to 2025 showed a preserved left ventricular ejection fraction (LVEF 65–75%). At presentation, cardiac biomarkers showed a normal BNP and flat, minimally elevated troponins. Transesophageal echocardiography confirmed an acute rupture of the posteromedial papillary muscle head and associated chordae causing severe (4+) mitral regurgitation. Open surgical intervention was deferred due to advanced malignancy and goals of care. Her acute heart failure was optimized medically with intravenous loop diuretics, low dose lisinopril for afterload reduction, and metoprolol succinate, while home amlodipine and hydrochlorothiazide were discontinued. She stabilized and is undergoing evaluation for transcatheter edge-to-edge repair. Discussion While a direct causal link is unproven, this case highlights a rare structural complication. We present this “two-hit” model as a hypothesis-generating observation, suggesting that chemotherapy-induced structural changes might compound underlying ischemic or radiation-induced vulnerabilities. As such, advanced imaging modalities may offer value in future efforts to implement risk-adapted surveillance.
Reference Key
openalex_W7171878050 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Shivam Desai, NARAYANA R GANDHAM
Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag566
URL
https://doi.org/10.1093/ehjcr/ytag566
Keywords Keywords not found

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