Acute mechanical complications of coronary arterial disease. Surgical correction.

Mechanical complications that cause heart failure after acute myocardial infarction may be corrected early by surgery. The development of effective cardiac assistance by intra-aortic balloon pumping (IABP) has proved invaluable in resuscitating patients in over-whelming cardiac failure, maintaining them during diagnostic evaluation, and affording long-term (up to two weeks) postoperative support. Four of five patients with acutely expanding ventricular aneurysms, two of six patients with acute mitral regurgitation, and one of two patients with acute ventricular septal defects are living and well. Ten of these 13 patients required IABP. Seven of the group, which was totally refractory to medical therapy, are long-term survivors as a result of this combined supportive, diagnostic, and surgical approach. Usually the heart can be repaired successfully. Patients are lost primarily from the ravages, prior to surgery, of over-whelming cardiac failure on other organs.