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[Clinical evaluation of perioperative myocardial infarction as a complication of valve replacement]
Insights
Perioperative myocardial infarction (PMI) is rare in valve surgery but occurred in 6 cases. Despite requiring interventions like IABP, patients showed good long-term exercise capacity, suggesting a manageable prognosis with preventative measures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Context:
- Perioperative myocardial infarction (PMI) is a recognized complication following coronary artery bypass grafting.
- PMI is infrequently observed in patients undergoing valvular surgery.
- This study investigates PMI occurrences in patients who underwent valve replacement surgery.
Purpose:
- To report and analyze cases of perioperative myocardial infarction (PMI) in patients undergoing valve replacement surgery.
- To identify potential causes and diagnostic criteria for PMI in this specific patient cohort.
- To evaluate the long-term outcomes and prognosis of patients experiencing PMI after valve replacement.
Summary:
- Six patients (5 male, 1 female; mean age 47±8 years) developed PMI after valve replacement using blood cardioplegia.
- Diagnosis was confirmed by elevated CPK-MB, new ECG Q waves, and positive 99mTc-PYP scans.
- Inferior (4) and posterior (1) infarctions were most common; 3 patients needed IABP, but all achieved good exercise capacity.
- Potential causes include coronary air embolism, spasm, and inadequate hypothermia.
Impact:
- Highlights that PMI, though rare, can occur during valve replacement surgery.
- Emphasizes the importance of diagnostic vigilance for PMI in valvular surgery patients.
- Suggests that with appropriate management and preventative strategies, the prognosis for PMI in valve replacement patients may not be uniformly poor.
- Informs clinical practice regarding the recognition, management, and prevention of PMI in the context of cardiac valve surgery.
Abstract:
Perioperative myocardial infarction (PMI) is a well-known complication of coronary artery surgery, but rarely encountered in valvular surgery. We have experienced 6 cases of valve replacement with PMI, using blood cardioplegia since 1979. Those patients (5 men, one woman; mean age 47 +/- 8 years) had no previous angina, and preoperative CAG revealed no significant stenosis. Three patients were reoperative cases. A diagnosis of PMI was established by the following criteria; an abnormal increase in maxCPK-MB (greater than 150 IU/l), new Q waves at ECG, positive 99mTc-PYP scan (grade 3-4). The area of PMI was inferior in 4 patients, posterior in one, and anterior infarction was seen in only one case. Three cases required IABP, but all 6 cases showed good exercise capacity by Treadmill exercise test in late stage. Several factors are thought to be the cause of PMI at valvular surgery; such as coronary air embolism, perioperative coronary spasm, inappropriate topical hypothermia, etc. Prognosis is not necessarily poor, however much attention should be paid to prevent PMI in valve replacement.