We report a 70 year old female patient who underwent three successful surgical repairs for the following postinfarction mechanical complications: left ventricular free wall rupture (LVFWR), ventricular septal perforation (VSP) and left ventricular pseudoaneurysm (LVPA). The patient had an oozing type LVFWR following PTCA and t-PA therapy for acute broad-anterior myocardial infarction. Initially, treatment of the LVFWR consisted of emergency pericardial wrapping over the infarcted myocardial area. However, on the second postoperative day the patient developed VSP, which necessitated patch closure of the VSP and patch plasty of the left ventricle. An LVPA, which was detected by UCG examination 38 days after the second procedure, was repaired successfully through a left antero-lateral thoracotomy and with femoro-femoral bypass. The patient made a full recovery and was discharged on the 200th postoperative day. In conclusion, UCG is an effective diagnostic method for postinfarction mechanical complications and pericardial wrapping over an infarcted area is a safe and useful method for an oozing type LVFWR. In addition, it is important that appropriate surgical repairs for postinfarction mechanical complications should be performed without delay.
Between January and December 1991, six patients aged 80 years or older underwent coronary artery bypass grafting (CABG). Five cases were female, the mean age was 83 years, and the oldest was 90 years of age. Of these patients, five were of 3 vessels disease, three of whom had left main trunk lesions as well. Five cases were classified as NYHA-IV, four of whom required inotropic support, and two needed IABP support preoperatively. Emergency CABG was performed in five patients. As a result, all patients needed extensive postoperative care and extended hospital stays. However, five cases survived, and there was one hospital death due to severe left ventricular dysfunction (hospital mortality; 16.7%). We conclude that CABG in patients 80 years or older, although associated with longer ICU and hospital stay, can give good operative results and that patients should not be denied CABG because of age alone.