SURGERY FOR THE MECHANICAL COMPLICATIONS OF MYOCARDIAL-INFARCTION IN ISCHEMIC-HEART-DISEASE

In the December 1989 issue of Current Opinion in Cardiology (4:771-811) many aspects of coronary artery surgery were reviewed, including the ever-increasing importance of the internal mammary artery in revascularization and the role of coronary artery bypass grafting in treating acute myocardial infarction after angioplasty and thrombolysis. A major review of the current role of surgery in the management of ischemic heart disease was published as a supplement to Circulation [1]. This supplement incorporates many collective reviews of the literature and gives an outstanding overall view of the current role of coronary artery bypass surgery and associated procedures in the management of ischemic heart disease. Over the last year, several reports on treating the mechanical complications of acute myocardial infarction have appeared, and a review of these complications seems appropriate because they remain a difficult management problem and are associated with a high surgical risk as compared with that of isolated coronary artery bypass surgery. The mechanical complications of myocardial infarction are 1) ventricular septal defect, 2) mitral regurgitation, 3) left ventricular aneurysm with its associated risk of ventricular tachycardia, and 4) left ventricular free wall rupture.