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PubMed1977

[Emergency treatment of mechanical complications of acute myocardial infarction. Septum perforations and mitral insufficiency].

Over the last three years, thanks on the one hand to improvements in surgical techniques and ressuscitation, and on the other to assisted circulation using the intra-aortic balloon, which allows improved preoperative preparation of the patients, urgent medicosurgical treatment of the mechanical complications of infarction has improved the prognosis by comparison with the recent past. During the above period, our figures for operative intervention during the first two weeks after an acute infarction have been as follows: 1. Twenty nine cases of septal perforation (17 of which had previously had assisted circulation by balloon): there were 8 immediate deaths and 8 successful cases (no secondary deaths over a follow-up period of from 2 to 41 months). In all these cases, the surgeon approached the perforation by way of the left ventricle. No patient required an additional bypass procedure. Where indicated, assisted circulation by means of a balloon should not be continued for more than a few days. If there is no improvement with its use, it seems unreasonable to proceed to surgery regardless. 2. Ten cases of acute mitral incompetence; 8 were due to ruptured papillary muscle and two to mal function. 5 patients out of the 10 had required circulatory assistance by balloon preoperatively. There were 2 immediate deaths and 8 successful cases, with one secondary death (follow-up period of between 2 and 37 months).

Acute Disease↗
PubMed1977

[Value of intra-aortic counterpressure as circulatory support in cardiac surgery. Apropos of 60 cases].

Assisted circulation (AC) by intra-aortic counterpressure (IACP) has been used in 60 patients either pre- and postoperatively after a complication of acute myocardial infarction (25 patients: group A), or for a low-output syndrome after extracorporeal circulation (ECC) occurring in the operating theatre (20 patients: group B), or secondarily (15 patients: group C). In group A cases, the IACP stabilised a the myocardial ischaemia, and permitted coronary arteriography and subsequent surgery with little risk. Out of the 8 patients in this group who had cardiogenic shock only 4 survived, whereas out of the 17 patients without shock, only one died. Of the group B and C patients, 58% responded favourably to IACP, and 75% of group B cases survived as against 33% of group C. The postoperative low-output syndrome is related not to the ECC itself but to ischaemia of the subendocardial vasculature during surgery. The incidence of this syndrome can be reduced by the use of improved techniques of myocardial protection. AC by means of IACP becomes an effective therapeutic weapon if it is used early, or even systematically when the ejection fraction is below 0.03 and/or the EVR is less than 0.80.

Adult↗
PubMed1977

[Massive mitral insufficiency due to spontaneous and isolated rupture of a posterior papillary muscle. Echocardiographic study, treatment by assisted circulation and prosthetic valve replacement].

The authors report a case of a patient of 72 years of age in whom the sudden onset of severe left ventricular failure led to the discovery of massive mitral incompetence. The diagnosis of rupture of the posterior papillary muscle of the mitral valve, which was suggested on clinical and echocardiographic grounds, was confirmed at operation. This was carried out after 72 hours of assisted circulation by counter-pressure, and consisted of a replacement by a prosthetic valve. The authors emphasise, in the light of this case, the importance of echocardiography by ultrasound in the early diagnosis of this type of acute mitral incompetence, clarify the signs, and emphasise the part played by assisted circulation with an intra-aortic balloon in the treatment of this condition.

Aged↗
PubMed1978

[Resections of the left ventricle in the surgical treatment of parietal sequelae of myocardial infarct].

Resection of left ventricular tissue seems to be playing an increasing part in the treatment of the sequelae of myocardial infarction. In a total of 700 patients who underwent surgery for some aspect of coronary atherosclerosis, 40 underwent resection of left ventricular tissue. In the majority of cases, diagnosis rested on left ventricular cine-angiography and in 3 cases this had to be carried out as an urgent procedure with circulatory assistance using diastolic counter-pressure (DCP) from an intra-aortic balloon. A selective contrast technique for the two coronary arteries was used whenever possible. The surgical anatomy of the lesions indicates a difference between a localised dyskinesia and diffuse dyskinesia, the latter having a severe effect on left ventricular function. In a group of localised dyskinesias, the territory supplied by the anterior descending artery was by far the most frequently affected. Resection of left ventricular tissue was associated with a myocardial bypass revascularisation procedure in 9 cases, valve repair in 7 cases, and closure of a septal perforation in 3 cases. The total inpatient mortality rate is still quite high (23.1%) because of the severity and widespread nature of the coronary disease. However, the mid-and long-term results are good, the criteria being functional improvement and the actuarial 4-year survival rate.

Adult↗
PubMed1979

[Use of the method of counterpulsation by means of an intra-aortic balloon in the treatment of myocardial infarct].

The results of applying counterpulsation with an intraaortic balloon in the treatment of 17 patients suffering from myocardial infarction are discussed. Counterpulsation was indicated in 15 patients because of cardiogenic shock and in 2 (with concomitant arterial hypertension) because of expansion of the zone of myocarial infarction against the background of unstable arterial pressure. Nine patients died, counterpulsation in these cases was begun 5 hours after the appearance of the shock symptoms or later. A comparative analysis of hemodynamic changes associated with counterpulsation in patients who survived and in those who died is made.

Adult↗
PubMed1979

[Acute mitral incompetence of ischemic origin (author's transl)].

Clinical findings and results of treatment in 17 patients with acute mitral incompetence are described. The lesions were secondary to a recent myocardial necrosis causing severe cardiac failure (shock, or acute left ventricular failure), and the presence of mitral incompetence was confirmed by right catherization (15 cases) and/or left ventricular angiography (13 cases). The anatomical lesions are described in 14 cases: rupture of the posterior mitral papillary muscle in 7 cases, and acute dysfunction of the muscle in 7 other cases. Eight patients were treated by an intra-aortic balloon to assist circulation, and 14 were given vasodilators (phentolamine, trinitrin) associated in 5 cases with positive inotropic drugs. Surgical treatment was given (mitral valve replacement) in 7 cases. The respective effects of vasodilators and circulatory assistance are discussed, as well as the indications for, and results of urgent surgical treatment (6 successes in 7 operations).

Acute Disease↗