Background To assess optimal timing for coronary artery bypass graft surgery (CABG) after an acute myocardial infarction (AMI), all patients undergoing CABG without associated procedures at our institution from January 1, 1991, to July 30, 1992, were reviewed. Patients were divided into three groups based on time from infarct to revascularization. The control group consisted of patients operated on for angina refractory to medical management. Relative risks (incident infarction group divided by incident control group) were established for need of vasopressors, new balloon to separate from bypass, perioperative myocardial infarction, and hospital mortality. Methods and Results One hundred sixteen patients underwent CABG within 6 weeks of infarction. In the experimental group, 58 patients underwent CABG for non–Q-wave infarction, and 58 patients underwent CABG for Q-wave infarction. In the control group, 255 patients underwent surgery for angina without infarction. Patients were analyzed by group relative to the time between infarction and CABG. Patients were analyzed between infarction and CABG and assigned to one of three groups. Group 1 patients were revascularized within 48 hours; group 2, between 3 and 5 days; and group 3, after 5 days. Significance was determined by Fisher’s exact or Mantel-Haenszel χ 2 test where appropriate. Multivariate analysis was performed on statistics that were significant. All patients within all groups after Q-wave or non–Q-wave myocardial infarction had a significantly higher risk of needing an intra-aortic balloon pump and vasopressors to be weaned from bypass and a greater incidence of perioperative MI compared with control patients. Surgical mortality is highest immediately after Q-wave infarctions. Conclusions Patients with non–Q-wave infarction may undergo CABG relatively safely at any time. Acceptable timing for CABG after Q-wave infarction is after 48 hours.
Mitral valve injury from blunt trauma to the chest is an uncommon entity. We report a case of mitral valve injury after a fall, and its repair. The English literature is reviewed from the earliest report in 1873 to the present. The diagnosis, types of injury and surgical correction are discussed.
The occurrence of a rectal adenocarcinoma in a 48-year-old man 11 years after he received a cadaveric renal transplant is reported. Since his operation, the patient had been receiving prednisone and azathioprine for immunosuppression. The occurrence of rectal carcinoma in this patient at an early age, after a decade of immunosuppression, suggests an association between the malignancy and his altered immunologic state. Although an increased incidence of skin and reticuloendothelial malignancies in the first five years following renal transplantation has been well documented, few colorectal carcinomas have developed in these patients. Follow-up of transplant patients, however, is only now passing ten years in large numbers of patients. This case suggests that there may be a ten year latency period before transplant patients develop colorectal carcinoma. Such a time course would be similar to that seen in patients with chronic ulcerative colitis, in whom colorectal carcinomas are found. Surveillance colonoscopy for transplant patients beginning ten years after surgery may be necessary.
