[Myocardial infarction in early postoperative complications in operations of myocardial revascularization: incidences, clinical study and mechanisms]. / L'infarctus myocardique dans les suites précoces de la chirurgie de revascularisation myocardique: incidence, étude clinique et mécanismes

ABSTRACT

A study of the electrocardiograms and enzyme levels after surgery to revascularise the myocardium in a group of 174 consecutive patients has allowed us to demonstrate 19 cases of early postoperative myocardial infarction (EPOMI) (10.9%). 10 of these cases had no clinical features of EPOMI; 9 had clinical signs (collapse of altered systemic pressures, arrhythmias) or haemodynamic disorders (raised left atrial pressure). The EPOMI turned out to be fatal in 3 cases (19%), and to be complicated by left ventricular failure in 6 cases (32%). Post-operative coronary arteriography showed that 8 out of 20 grafts were occluded in 13 patients; ventriculography showed the myocardial damage consequent upon EPOMI in 8 patients out of 12; Autopsy showed graft occlusion in each of the two patients. The means of diagnosis of EPOMI must be electrocardiographic and enzymatic. An attempt has been made to study the causes of EPOMI aortocoronary bypass hazardous because of poor distal supply (6 cases) or surgical difficulties (6 cases); progression of the atheromatous lesions (3 cases); infarct already inicipient at the time of surgery (1 case). EPOMI is a complication of cardiac surgery which must be recognised; the mechanisms are diverse, and any of the factors which are relevant to the surgical procedure may be a cause.