COMBINED DELIVERY OF MYOCARDIAL PROTECTION (ANTEROGRADE AND RETROGRADE) IN A PATIENT WITH ACUTE MYOCARDIAL INFARCTION AND SECONDARY SEVERE ISCHEMIC MITRAL REGURGITATION
Abstract:
In patients with severe coronary injuries, anterograde cardioplegia does not provide adequate protection due to an inhomogenous distribution. In these situations, combined administration (anterograde and retrograde) of cardioplegic solution may be an alternative for myocardial protection during aortic crossclamp. The aim of our work is to present a case in which myocardial protection was achieved by intermittent anterograde and retrograde administration of warm blood cardioplegia. A 62 years old patient presented to interventional cardiology with symptoms of severe pectoral angina and severe dyspnea followed by acute pulmonary edema. ECG demonstrates acute postero-inferior myocardial infarction. Echocardiography reveals severe mitral regurgitation by rupture of the posterior papillary muscle. Coronary angiography showed critical stenosis of the left main coronary artery, 70- 80% stenosis of the anterior descending artery, obtuse marginal artery and right coronary artery. Given the severe and the severe altered clinical status, the proximal coronary lesions and the mechanical complications of the myocardial infarction, emergency surgical intervention was performed: replacement of the mitral valve with a mechanical prosthesis and double aorto-coronary bypass with autologous saphenous vein During aortic crossclamp (109 minutes) myocardial protection was achieved by combined administration of 500 ml warm blood administered antegrade in the aortic root, followed by another 500 ml administered ratrograde in the coronary sinus, this cycle being repeated intermittent every 20 minutes. After aortic declamping aortei the heart start beating spontaneously, at the weaning of the extracorporeal circulation being needed only small doses of Dobutamine (7 μg/kg/minute) and Norepinephrine (180 ng/kg/minute) and intraaortic balob contrapulsation (IABP). The postoperative recovery was good, the pacientul being discharged home at 12 days after the operation. In conclusion we can say that the cardioplegic solution administered intermittently in combined mode (anterograde and retrograde) offers a good myocardial protection in the patient with of severe coronary lesions
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