Surgical management of complications

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From September 1977 until July 1979 percutaneous transluminal dilatation of coronary stenosis was performed in 82 patients. The obvious potential for complications inherent to this method has prompted a mandatory surgical standby during all dilatation procedures. The cardiac surgical team is alerted during percutaneous transluminal dilatation, but the elective procedures are continued; the actual dilatation takes place during the period when the first case in the operating room is just being finished and the next has not yet been started. The primary purpose of emergency aortocoronary bypass grafting for complications of percutaneous transluminal dilatation is the reestablishment of blood flow to a suddenly obstructed coronary artery. As a corollary to this demand, the loss of the myocardial muscle mass must be kept at minimum and this is best accomplished by the rapid institution of cardiopulmonary bypass. The unloading of the heart by the pump oxygenator reduces the myocardial oxygen consumption by 50%, eliminates the dangerous arrhythmias, and restores the normal hemodynamics in cases of sudden left ventricular pump failure.


Emergency aortocoronary bypass grafting was necessary in 7 of 82 patients subjected to percutaneous transluminal dilatation. In addition, symptoms of beginning myocardial infarction developed in one patient several hours after percutaneous transluminal dilatation but, due to a communication breakdown, was not seen by the surgeon until a well-established myocardial infarction with an enzyme release had developed; this patient was treated by medical management alone. The indication for emergency coronary grafting was either a sudden complete occlusion of a previously stenosed . . .



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