In acute myocardial infarction there are several treatments that try to reduce the dammage of left ventricle. The surgical treatment is one of the more important procedures after the use of thrombolitics and the complications of PCA. From July 87 to July 89, in the Instituto do Coração da Santa Casa de Ribeirão Preto, 262 myocardial revascularization surgeries were performed and 23 (8.7%) of those surgeries were during acute myocardial infarction. The patients included 19 males and 4 females. The range of age was 42 to 75 (mean: 58 yeats). The surgery was indicated for: pain, 15 (65%) cases: coronary opened by thrombolitics, 5 (22%); coronary expontaneous opened, 2 (9%) cases, and multiarterial coronary disease, 1 (4%) case. There were some factors associated with the surgery in the acute myocardial infarction: complicated TPA, 8 cases; previous use of thrombolitics, 7 cases; unsuccessful TPA, 4 cases; cardiac arrhythmia, 2 cases, and cardiogenic shock, 1 case. The localizations of the AMI were: antero wall, 14 (60.8%); posterior wall, 9 (39.2%) cases. The dammage of the myocardial wall was: transmural, 18 (78.2%) cases; subendocardial, 4 (17.3) cases, and unknown, 1 (4.3%). The range of CKMB was 15 U to 104 U (mean: 58.7 U). The left ventricle was normal in 5 cases and the other cases had variable degrees of hypocontractility. The coronary artery involved was: only lesions of the related AMI-coronary, 9 (39.1%) cases; lesion of the AMI coronary associated with lesions of other arteries, 8 (34.7%) cases; lesion of the AMI artery associated with previous myocardial infarction, 3 (13%) cases, and occluded AMI coronary associated with lesions of other arteries, 3 (13%) cases. The time of AMI surgery was 2 hours to 2 weeks (mean: 4.6 days). The relation bypass/patient was 1.7. The myocardial protection was made with discret hypothermia and crystaloid cardioplegic solution. The myocardial anoxia ranges 14 minutes to 50 minutes (mean: 16.3 minutes). The hemodynamic conditions were stable in all but 3 cases that needed inotropic drugs and longer time of assisted circulation. The postoperative follow-up shows complications in 10 (43.4%) and 3 (13%) deaths. The deaths were related with cardiac, pulmonary and neurological causes. The surgical approach in the AMI is growing up, despite os the increment of the mortality and postoperative complications. Selection of patients for operation during AMI must be individualized.
myocardial infarct, acute; myocardial infarct surgery; myocardial revascularization