[Emergency direct revascularization of the myocardium in acute infarct]

A new surgical conception of urgent direct revascularization of the myocardium in acute infarction is discussed and substantiated. Clinical observations and results of 13 urgent operations for aorto-coronary shunting in 10 patients with acute myocardial infarction are analysed (double aorto-coronary shunting was performed in 3 cases). Indications to urgent revascularization of the myocardium in infarction were as follows: no effect of drug therapy during 2--3 hours since its onset, a failure to eliminate pulmonary edema and cardiogenic shock in a localized proximal occlusion of the coronary artery, revealed during a planned or urgent coronarography. Three patients were operated upon in the state of cardiogenic shock (one after reanimation), two with pulmonary edema. All these patients (excluding one with pulmonary edema) have made a good recovery. Three patients died. Good immediate and late results obtained evidence the advantage of this policy. The problems of most optimum terms for urgent revascularization of the myocardium are discussed.