SURGERY FOR MECHANICAL COMPLICATIONS AFTER ACUTE MYOCARDIAL-INFARCTION

Reviewed are the current surgical methods for the treatment of mechani cal complications after an acute myocardial infarction, specially the subacute ventricular rupture, the most frecuent complication, and in w hich we have the greatest experience in the world. Mechanical complica tions constitute the second cause of death after myocardial infarction , following pump failure. The most frequent mechanical complication is ventricular rupture, which is the cause of death in 26% of the cases of acute myocardial infarction. The setting of solid diagnostic tools, with the association of echocardiographic and hemodynamic criteria, h as permited the identification of a large number of patients with suba cute ventricular rupture before death, and has allowed them to be trea ted surgically. The surgical techniques have evolved to more conservat ive methods and, nowadays, nearly all the patients can be operated on without extracorporeal circulation and using sutureless techniques. Th e result is greater surgical survival with satisfactory functional sta tus at follow up. The incidence of septal and papillary muscle rupture is considerably less frequent, but of great interest. The surgical re sults have been improved on the basis of early diagnosis, aggressive s urgical attitude, and better reparative and myocardial protection tech niques.