[Acute coronary surgery].

Abstract

While the indications for surgical treatment of chronic angina pectoris are exactly defined, the delineation between conservative and surgical therapy of acute complications of coronary diseases is not standardized. The application of possible surgical procedures to acute coronary surgery (aorto-coronary bypass, infarctectomy, correction of post-infarction ventricular septal defects and mitral insufficiency) are discussed in relation to the following clinical pictures: 1. Unstable angina 2. Surgery after myocardial infarction a) recent infarction b) cardiogenic shock after infarction c) impending reinfarction d) post-infarction tachyarrhythmia unresponsive to conservative and electrical therapy e) acute heart failure caused by post-infarction defect of the ventricular septum or by mitral insufficiency. The following therapeutic guide-lines can be laid down on the basis of an analysis of experience gained in this field by other workers and ourselves: surgical therapy is indicated in the cases of unstable angina, impending reinfarction, or acute heart failure caused by a post-infarction ventricular septal defect or by mitral insufficiency which do not respond rapidly to conservatives measures. By contrast, the superiority of surgical intervention, even with the assistance of intraaortic balloon pumping, has not yet been established for the treatment of the remainder of the above-mentioned clinical pictures and requires evaluation by further investigations.