Postmyocardial infarction complications requiring surgery

Papillary muscle rupture, ventricular septal defect, and ventricular aneurysm represent complications of myocardial infarction that require surgical intervention. Since operative mortality and morbidity are increased in proportion to the degree of myocardial and pulmonary disease, early diagnosis and surgical intervention is mandatory. Diagnostic procedures of choice include careful and serial ECG analysis and cardiac auscultation, especially in patients with postinfarction refractory angina or congestive heart failure; Swan-Ganz catheterization, echocardiography; and, in appropriate instances, ventricular and coronary angiography should also be performed preoperatively. With early identification of patients at risk of developing these complications, and careful preoperative hemodynamic studies, surgical repair should lead to improvement in myocardial function and more effective response to post-operative medications in patients previously resistant to such therapy.