III. Attempts at Emergency Surgical Treatment

Abstract

The constant observation of patients in coronary care units (CCUs) permits a rapid diagnosis of rupture of the free left ventricular wall and resulting cardiac tamponade. This has allowed for a surgical trial in three patients to relieve the tamponade and to repair the rupture. No patients survived hospitalization. One patient died of a new rupture six hours after successful repair of the original one. The next patient survived for one month but suffered from severe brain damage as a consequence of excessive bleeding during the intervention. The third patient died during the attempts of suturing a new rupture of the myocardium, three hours after the first rupture. The experience shows that a CCU staff can 1) quickly and correctly diagnose a rupture with tamponade, 2) relieve the tamponade and 3) stop the gross bleeding. The main problem does not seem to be to prevent the myocardial sutures from cutting but rather the occurrence of new ruptures. Further attempts with varying techniques seem justified.