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Surgical Treatment of Mechanical Complications of Myocardial Infarction

Sarah A. Schubert, MD, Irving L. Kron, MD
Surgical Treatment of Mechanical Complications of Myocardial Infarction is a topic covered in the Adult and Pediatric Cardiac.

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Introduction

Although mechanical complications occur with only a small fraction of acute myocardial infarctions (AMI), these types of complications are some of the most lethal and catastrophic complications of AMI. Depending on the coronaries affected and extent of infarcted territory, mechanical complications include ventricular septal rupture (VSR), left ventricular free wall rupture (LVFWR), and papillary muscle rupture (PMR). With medical management only, each of these complications carries mortality between 80% and 100% within 2 months of onset.[1] Even with well-timed surgical intervention, mortality from each of these complications remains high.[2] Fortunately, with the advent of thrombolysis, percutaneous coronary interventions, including angioplasty and stent placement, and an increasing number of coronary artery bypass grafting (CABG) operations, these sequelae of AMI now complicate less than 1% of AMIs.[2]

Nevertheless, hundreds of patients will sustain these various myocardial ruptures each year. Although less frequently encountered in routine adult cardiac surgical practice, these complications still necessitate rapid diagnosis, appropriate acute hemodynamic stabilization, and, most importantly, well-timed and thoughtful surgical intervention. Here we review the major tenets of pathophysiology, diagnosis, and surgical repair for these structural and mechanical complications following AMI.

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Introduction

Although mechanical complications occur with only a small fraction of acute myocardial infarctions (AMI), these types of complications are some of the most lethal and catastrophic complications of AMI. Depending on the coronaries affected and extent of infarcted territory, mechanical complications include ventricular septal rupture (VSR), left ventricular free wall rupture (LVFWR), and papillary muscle rupture (PMR). With medical management only, each of these complications carries mortality between 80% and 100% within 2 months of onset.[1] Even with well-timed surgical intervention, mortality from each of these complications remains high.[2] Fortunately, with the advent of thrombolysis, percutaneous coronary interventions, including angioplasty and stent placement, and an increasing number of coronary artery bypass grafting (CABG) operations, these sequelae of AMI now complicate less than 1% of AMIs.[2]

Nevertheless, hundreds of patients will sustain these various myocardial ruptures each year. Although less frequently encountered in routine adult cardiac surgical practice, these complications still necessitate rapid diagnosis, appropriate acute hemodynamic stabilization, and, most importantly, well-timed and thoughtful surgical intervention. Here we review the major tenets of pathophysiology, diagnosis, and surgical repair for these structural and mechanical complications following AMI.

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Last updated: February 26, 2020