[Emergency aorto-coronary bypass surgery for patients with right ventricular infarction]

Infarction of the right ventricle occurs with acute inferior myocardial infarction and results in a unique syndrome, characterized by distended neck vein, hypotension, heart block and spontaneous recovery in right ventricular function with time. We performed aorto-coronary surgery for four patients with right ventricular infarction. Three of them had emergency surgery. Surgical indications were refractory angina pectoris in two and cardiogenic shock in one. Postoperative courses in these patients were stormy and two died. Low output syndrome rarely improved with volume load alone and required inotropic and vasoactive drugs. Antiarrhythmic therapy including artificial pacing was especially important in keeping IABP support effectively. Remaining case, on the other hand, were conservatively supported by IABP and drug therapy through the first two weeks after infarction and then operation was done for unstable angina. Postoperative course in this patient was uneventful. In conclusion, delayed surgical intervention may be considered in patients with right ventricular infarction if their hemodynamic condition in the early stage of infarction can be conservatively managed.