Surgical Intervention in Chronic Postinfarction Cardiac Failure

Abstract

Seven patients with severe, chronic postmyocardial infarction cardiac failure underwent open intracardiac operation following catheterization and quantitative biplane angiocardiographic studies. Four patients with mitral incompetence had valve replacements; three had dilated mitral rings and did not survive the immediate postoperative period. In contrast, the single surviving patient had papillary muscle dysfunction evident at surgery and had less severe myocardial impairment as indicated preoperatively by a lower end-diastole volume and higher ejection fraction. Three patients demonstrated significant clinical and hemodynamic improvement after resection of a sccared akinetic area of left ventricular myocardium. Although two of the three patients died within the first year of operation, neither died in congestive failure. The results of this study indicate that certain patients with chronic postinfarction heart failure may benefit from surgery.

Myocardial Infarctectomy

“…Glass et al (3) found that the cardiac output as well as the systemic blood pressure improved significantly following resection of experimentally induced infarction in animals. In man the hemodynamic studies published by Harman et al (5) and Lajos et aI. (10) showed that, after resection of old infarction, the majority of the patients improved in end-diastolic volume and pressure and in cardiac output.…”