Authors: Benjamin Rosenfeld, MD and Michael A. Evans, MD – Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern Feinberg School of Medicine


An 18-year-old adolescent male with a past history of Tetralogy of Fallot undergoes surgical pulmonary valve replacement complicated by myocardial ischemia secondary to coronary thromboembolism in the immediate postoperative period. Five days after surgery the patient develops cardiogenic shock secondary to severe mitral regurgitation and acute rupture of the posteromedial papillary muscle. Which coronary artery distribution is MOST LIKELY to contribute to posteromedial papillary muscle rupture?