Bibliographic Details
| Title: |
Hemorrhagic infarct following myocardial revascularization |
| Authors: |
Montoya, Alvaro, Mulet, Jaime, Pifarré, Roque, Brynjolfsson, Gissur, Moran, John M., Sullivan, Henry J., Gunnar, Rolf M. |
| Source: |
Journal of Thoracic and Cardiovascular Surgery; February 1978, Vol. 75 Issue: 2 p206-212, 7p |
| Abstract: |
Aorta-coronary bypass grafting is a widely established treatment for disabling angina. In the presence of an acute myocardial infarction, re-establishment of blood flow distal to the coronary obstruction may prevent cellular necrosis in the early stages. If this procedure is carried out late, adverse effects may result, such as severe arrhythmias, extension of the myocardial injury, and hemorrhage in the infarcted area. Three patients with an evolving myocardial infarct underwent myocardial revascularization. After the operation severe arrhythmias accompanied by low cardiac output syndrome were observed, and at postmortem examination large hemorrhagic infarcts were found. These patients motivated us to investigate reperfusion of the ischemic myocardium in the laboratory. Acute myocardial infarction was created in 29 dogs by ligating the left anterior descending coronary artery. The ligation was permanent in five dogs as a control group. In six dogs (Group II) reperfusion was carried out after 3 hours of temporary ligation, and in 18 dogs (Group III) the ischemic area was reperfused at 5 hours. The results revealed no hemorrhage in the control group, but hemorrhage in all of the reperfused animals. In Group II, 83 percent of the animals developed a small area of hemorrhage. In Group III, 67 percent of the animals developed a large area of hemorrhage. These results, analyzed together with our clinical experience, led us to conclude that revascularization of an ischemic myocardium should be undertaken as early as possible in order to reduce the amount of cell necrosis and at the same time avoid the complications of later reperfusion leading to hemorrhagic infarction. |
| Database: |
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