Cardiac Surgical Emergencies

This paper describes experiences in the management of cardiac surgical emergencies due to bacterial endocarditis, non-infective valve lesions, pulmonary embolism and coronary artery disease. Fifteen patients required urgent surgery for uncontrollable and rapidly increasing left ventricular failure due to bacterial endocarditis. Six of these patients are alive and well. Failure In nine cases resulted from preoperative combinations of pulmonary infection and oedema, cerebral emboli, extracardiac infection, and disruption of the annulus of the valves due to infection and aneurysm formation. Non-infective valve lesions included calcific aortic stenosis and, in particular, mitral stenosis complicated by pregnancy or intraatrial thrombus localized to the valve leaflets. Ten patients had pulmonary embolectomy under cardiopulmonary bypass; eight are alive and well. The diagnosis of this condition Is most accurately confirmed by pulmonary arteriography, but this investigation is not without danger. Pulmonary embolectomy was reserved for those desperately ill, those unresponsive to supportive measures and those who had recently undergone operations. Six patients underwent operation for impending cardiac infarction. In general, the presentation was the same in each case—namely, sudden onset and persistence of severe angina unrelieved by the usual methods, S-T/T-wave changes and ventricular arrhythmias. All patients were completely relieved by operation. There was one late death. Patients in cardiogenic shock have been managed by counterpulsation with an intraaortic balloon catheter. One of these was considered to have a remediable lesion, but operation was unsuccessful.