[Surgery of mechanical complications of acute myocardial infarct]

Reviewed are the current surgical methods for the treatment of mechanical complications after an acute myocardial infarction, specially the subacute ventricular rupture, the most frequent complication, and in which we have the greatest experience in the world. Mechanical complications 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, has permitted the identification of a large number of patients with subacute ventricular rupture before death, and has allowed them to be treated surgically. The surgical techniques have evolved to more conservative methods and, nowadays, nearly all the patients can be operated on without extracorporeal circulation and using sutureless techniques. The results is greater surgical survival with satisfactory functional status at follow up. The incidence of septal and papillary muscle rupture is considerably less frequent, but of great interest. The surgical results have been improved on the basis of early diagnosis, aggressive surgical attitude, and better reparative and myocardial protection techniques.