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PubMed1991

Surgical treatment of acute myocardial infarction.

In recent years, advances in surgical techniques and perioperative management of cardiac surgical patients have facilitated more aggressive operative treatment of many serious and even catastrophic complications of acute myocardial infarction (MI). In addition, improved understanding of the natural history of these complications has helped to optimize the indications for and timing of surgical intervention. The role of emergency revascularization for postinfarction angina, evolving acute MI, cardiogenic shock after acute MI, and failed percutaneous transluminal angioplasty has expanded with overall satisfactory to excellent results. Surgical treatment of mechanical with overall satisfactory to excellent results. Surgical treatment of mechanical complications of acute MI such as free-wall rupture, acute ischemic mitral insufficiency, and ventricular septal defect also is undertaken earlier and more aggressively. Although the mortality rates for these conditions remain higher than desired, salvage of many previously doomed patients now is a reality.

Acute Disease↗
PubMed1991

Complicated acute myocardial infarction. Heart failure, shock, mechanical complications.

In-hospital mortality in patients with acute myocardial infarction is predominantly related to heart failure or shock and mechanical complications (acute mitral regurgitation, ventricular septal rupture, and free wall rupture). Heart failure and shock are primarily the consequences of contractile dysfunction of the left ventricle. Use of inotropic agents and assist devices are temporizing measures; early reperfusion with salvage of ischemic interventricular septum or free wall, resulting in severe mitral insufficiency, left to right shunt, and acute tamponade, respectively, necessitates immediate diagnosis and surgical intervention.

Acute Disease↗
PubMedDate not supplied

Repair of both papillary and free wall rupture following acute myocardial infarction.

A 60-year-old patient with rupture of the papillary muscle combined with free wall rupture secondary to myocardial infarction is described. Transesophageal echocardiography was useful in making the diagnosis. Surgery was performed 2 days after the onset of acute myocardial infarction, and patch reinforcement of the ruptured wall and mitral valve replacement were effective. Only one case of this type of double rupture has been reported, and this is the first case to have been repaired surgically. It may be unusual for double rupture to occur because the first rupture decreases wall stress to less than the normal level.

Coronary Angiography↗
PubMedDate not supplied

[Current causes of mortality in acute myocardial infarction].

The mortality rate of acute myocardial infarction (AMI) has decreased from 50% in 1926 to 9% nowadays. The reason for this change has been the development of coronary care units, the use of new inotropic agents, antiarrythmic drugs, pacemakers, as well as the better knowledge of the right ventricular infarction and heart failure. We studied 100 fatal AMI (group II) out of 1187 patients admitted to the Instituto Nacional de Cardiologia "Ignacio Chávez" CCU up to august 1987 and compared them with 500 survivors of acute coronary occlusion in the same period., (group I) - In both groups there were more men between 50 and 70 years. Females older than 60, had a higher mortality rate. Twenty patients died with clinical evidence of tamponade, five of them had left ventricular rupture at autopsy. The fatal AMI group had higher rates of past history of myocardial infarction, also higher rates of persistent angina, myocardial re-infarction, 3er degree AV block and RBBB. The more frequent causes of death were grade III-IV heart failure and left ventricular wall rupture.

Adult↗
PubMedDate not supplied

[Factors contributing to the onset of heart rupture in acute infarct].

The aim of this study was to find out the contributing factors for cardiac rupture in the course of acute myocardial infarction (AMI). Past medical histories and autopsy data of 80 patients were analyzed. The first group consisted of 30 patients who died due to heart rupture in the course of AMI and the control group of 50 patients who died from the other, more common complications of AMI. There was no difference between the groups according to age and sex of the patients. All patients who died from the rupture of the heart had a history of heavy chest pain, while it was lacking in 30% of the patients of the control group (p less than 0.01). All the first group patients showed electrocardiograms diagnostic for AMI, while it was lacking in 14% of the second group patients (p less than 0.05). Almost a half of the second group patients (47%) were in the class I of the Killip's classification, while only 20% of the control group did not developed left ventricular failure. Pathological study showed that the rupture of the heart most commonly occurred in the course of an anterior myocardial infarction. There was no difference according to the size of infarctions between observed groups, but the thickness of the left ventricular wall was significantly less (p less than 0.05) in the control group, and the heart weights were higher (p less than 0.05) in the control group. There was advanced atherosclerosis of the coronary arteries and about two thirds of the first group patients showed acute coronary thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Management of uncomplicated acute myocardial infarction: are there differences in patterns of care between VAMC physicians and private practice physicians?

Uncomplicated acute myocardial infarction is a diagnostic category in which significant changes in patterns of care have occurred in the past 17 years. In this retrospective study, a comparison has been made between actual practice patterns of VA physicians and those reported in literature. Findings demonstrated differences in: length of stay in a monitored bed-5 days vs. 2.8 days; drug preferences--calcium antagonists and nitrates vs. nitrates and plasminogen activators; pre-discharge diagnostic studies--cholesterol/triglyceride levels and coronary angiography vs. lipid levels and exercise electrocardiograms; and patient education--follow-up appointments and diet vs. smoking cessation, diet, and exercise programs.

Adult↗
PubMedDate not supplied

Apparent rupture of the ventricular septum after myocardial infarction in an infant with congenital heart disease.

Clinical and angiocardiographic simulation of rupture of the interventricular septum, in an infant with an endocardial cushion defect and documented myocardial infarction is reported. Close straddling of a proven congenital muscular apical ventricular septal defect by trabeculae carne is believed to have led to the angiocardiographic simulation of a post-infarction apical ventricular septal defect. In the surgical approach to post-infarction ventricular septal defects, the implication of such a simulation could be important.

Heart Rupture↗
PubMed1979

[Surgery of ventricular aneurysms and akinetic zones].

Operation was performed in 180 patients with post-infarction ventricular aneurysm (12 cases) or akinesia (92 cases). Simultaneously in 2 cases mitral valve replacement was performed and in 2 cases ruptured ventricular septum was treated by patch. The results are reported and discussed.

Adult↗
PubMed1979

[False aneurysm associated with mitral insufficiency due to rupture of the heart at the point of insertion of the anterior papillary muscle. A successfully operated case].

Although rupture of a mitral papillary muscle during myocardial infarction is well known, and post-infarction transmural ruptures causing false aneurysms occasionally reported, the association of rupture of the anterior papillary muscle and a underlying transmural parietal rupture giving rise to a false aneurysm is quite exceptional, and, to the best of our knowledge, has not previously been reported. Despite the serious nature of the disease, surgical cure of the aneurysm with mitral valve replacement was successful, due to the limitation of the anatomical disruption by early pericardial symphysis.

Aneurysm↗
PubMed1976

Post-infarction cardiac rupture.

Three allied conditions are described in this paper: (i) haemopericardium with cardiac rupture (5 cases); (ii) haemopericardium without rupture (2 cases); (iii) pseudoaneurysm (1 case). In the first 2 of these, the significant features were clinical deterioration with shock 3 or more days after infarction, recurrent cardiac pain, cardiac tamponade, and immediate or later ineffectiveness of counterpulsation. An additional feature in the second group was the development of haemopericardium after heparin therapy. In the third group, infarction followed by left ventricular failure and progressive cardiac enlargement was the significant feature. An apical systolic murmur was not present, as a false sac had not been formed. Ante-mortem diagnosis depends upon an appreciation of these features. Without it successful surgery is impossible. There were 4 survivors in this group of 8 patients.

Aged↗