Surgery for Complications of Acute Myocardial Infarction

W ITH THE GREATER availability of well-equipped and well-staffed coronary care units, death from arrhythmias complicating myocardial infarction has become less common.' This has been a result of improved methods of patient monitoring, earlier diagnosis of arrhythmias, and prompt treatment.2 3 Death from myocardial infarction at present is more commonly a result of cardiogenic shock or refractory cardiac failure." 3-5 The mechanical complications of myocardial infarction, including rupture of the interventricular septum, papillary muscle rupture, and acute left ventricular aneurysm, although uncommon, are associated wih a high mortality rate. Concomitant with the development of an accurate and safe method of selective cinecoronary arteriography6 for the diagnosis of coronary artery disease, effective surgical procedures for direct coronary arterial revascularization have evolved.7-10 Despite an impressive volume of patients undergoing elective revascularization, urgent myocardial