Emergency Surgery after Coronary Artery Disruption Complicating PTCA. Report of Four Cases

Four out of 150 patients having a PTCA at our institution sustained a coronary artery disruption and underwent emergency surgery. All of them presented a severe stenosis of the LAD, in 2 of them there was also a stenosis at the origin of a diagonal branch. In each case the injured vessel was a diagonal branch. Three patients had a rupture of subepicardial arteries and developed cardiac tamponade. In another patient the rupture was located intramyocardially. Severe hemodynamic derangement occurred in all 4 cases, one resulting in cardiac arrest. The latter was the only patient who died postoperatively, due to neurological damage. Two of the surviving patients sustained a non-transmural myocardial infarction in the area of the injured vessel. However, all 3 survivors recovered easily and are doing well 6 months after surgery.