Results and patterns of perioperative myocardial infarction.
Myocardial injury during a variety of cardiac surgical operations was determined in 57 patients by serial electrocardiograms (ECG's), serial determinations of serum creatine phosphokinase (CPK), and perioperative and postoperative technetium-99m stannous pyrophosphate (PYP) scans. ECG evidence of injury developed in four patients, whereas positive localized injury by PYP scan developed in ten. Twenty-one patients had elevated CPK enzymes postoperatively. The localization of injury by PYP scan correlated with ECG evidence of infarction in only one of four patients. Localized left ventricular injury by PYP scan without new Q waves on the ECG was common (5/12) in patients undergoing aortic valve replacement with perfusion of the coronary arteries. The injury in patients with congenital heart disease occurred at sites of ventricular incision or suggested possible air embolization of the coronary arteries. Perioperative infarction is frequently segmental and nontransmural and occurs in patients with coronary, valvular, and congenital heart disease.
D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013667:Technetium
D013667:Technetium; D003402:Creatine Kinase