Skip to main content

Advertisement

SpringerLink
Log in

Akuter aortokoronarer Bypass nach Koronardilatation

Acute aortocoronary bypass surgery following percutaneous transluminal coronary angioplasty. A report of 5 cases

Ein Berich über 5 Fälle

  • Originalien
  • Published:
Acta Chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Wegen einer Komplikation bei der perkutanen transluminalen koronaren Angioplastie (PTCA) mußte bei 5 Patienten notfallmäßig ein aortokoronarer Bypass angelegt werden. Zeimal war eine Dissektion, einmal eine Koronarembolie und bei 1 Patienten die «Ablōsung» eines atheromatōsen Plaque die Ursache der Perfusionsstōrung. Bei 1 Patienten trat 45 Minuten nach primär erfolgreicher Dilatation ein thrombotischer Verschluß auf.

Bei 4 Patienten mit erhaltenem koronaren Restfluß war postoperativ (mittlere Revaskularisationszeit 137 Minuten) eine Infarzierung nicht nachweisbar. Der Patient mit Gefäßverschluß erlitt trotz sofortiger Operation eine Vorderwandinfarzierung. Ein Patient verstarb 28 Stunden nach problemloser Revaskularisation am anaphylaktischen Schock nach einer Novalgin®-Injektion.

Durch einen akuten aortokoronaren Bypass kann bei Patienten mit einer akuten Ischämie während der PTCA—im speziellen bei erhaltenem koronarem Restfluß—die Entwicklung eines Myokardinfarktes verhindert werden.

Summary

The complication of acute myocardial ischemia following PTCA in 5 patients, made emergency aortocoronary bypass surgery necessary. The causes of ischemia were dissection of the vessel in 2 patients, an embolisation in 1 and a «luxation» of an atherosclerotic plaque in another patient. In 1 patient total occlusion of the coronary artery occurred 45 minutes after initial successful PTCA.

4 patients with residual coronary blood flow developed no myocardial infarction after emergency bypass surgery (mean revascularisation time: 137 minutes). 1 patient with total coronary occlusion suffered from an anterior myocardial infarction. Another patient died 28 hours after bypass surgery because of an anaphylactic shock after Novalgin®-injection.

In conclusion, emergency bypass surgery may prevent myocardial infarction in patients with acute ischemia during PTCA, especially in those with residual coronary blood flow.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Block, P. C., Myler, R. K., Stertzer, S., Fallon, J. T.: Morphology after transluminal angioplasty in human beings. N. Engl. J. Med. 305, 382 (1981).

    Article  PubMed  CAS  Google Scholar 

  2. Cowley, M., Bentivoglio, L., Block, P., Bourassa, M., Detre, K., Dorros, G., Gosselin, A., Grüntzig, A., Kent, K., Myler, R., Simpson, J., Stertzer, S., Williams, D., Mullin, S., Mock, M.: emergency coronary bypass surgery for complications of coronary angioplasty: NHLBI PTCA registry experience. Circulation 64, IV-193 (1981).

    Google Scholar 

  3. Dorros, G., Cowley, M. J., Simpson, J., Bentivoglio, L. G., Block, P. C., Bourassa, M., Detre, K., Gosselin, A. J., Grüntzig, A., Kelsey, S. F., Kent, K. M., Mock, M. B., Mullin, S. M., Myler, R. K., Passamani, E. R., Stertzer, S. H., Williams, D. O.: Percutaneous transluminal coronary angioplasty: report of the complications from the National Heart, Lung, and Blood Institute PTCA registry. Circulation 67, 723 (1983).

    PubMed  CAS  Google Scholar 

  4. Freudenberg, H., Lichtlen, P. R., Engel, H. J.: Zur transluminalen Angioplastie von Koronargefäßen; Analyse der wichtigsten Komplikationen aufgrund postmortaler Untersuchungen am menschlichen Herzen. Z. Kardiol. 70, 39 (1981).

    PubMed  CAS  Google Scholar 

  5. Grüntzig, A., Senning, A., Siegenthaler, W. E.: Nonoperative dilatation of coronary artery stenosis. Percutaneous transluminal coronary angioplasty. N. Engl. J. Med. 301, 61 (1979).

    Article  PubMed  Google Scholar 

  6. Hollmann, J., Grüntzig, A., King, S., Douglas, J.: Acute coronary occlusion immediately following percutaneous transluminal coronary angioplasty. Circulation 66 (Suppl. II), II-4 (1982).

    Google Scholar 

  7. Kaltenbach, M., Kober, G., Scherer, D.: Technik, Risiken, Früh- und Spätergebnisse nach Katheterdilatation von Kranzgefäßstenosen. Z. Kardiol. 71, 233 (1982).

    Google Scholar 

  8. Kent, K. M., Bentivoglio, L. G., Block, P. C., Cowley, M. J., Dorros, G., Gosselin, A. J., Grüntzig, A., Myler, R. K., Simpson, J., Stertzer, S. H., Williams, D. O., Fischer, L., Gillespie, M. J., Detre, K., Kelsey, S., Mullin, S. H., Mock, M. B.: Percutaneous transluminal coronary angioplasty: report from the registry of the National Heart, Lung, and Blood Institute, Am. J. Cardiol. 49, 2011 (1982).

    Article  PubMed  CAS  Google Scholar 

  9. Lee, G., Ikeda, R. M., Joye, J. S., Bogren, H. G., DeMaria, A. N., Mason, D. T.: Evaluation of transluminal angioplasty of chronic coronary artery stenosis. Value and limitations assessed in fresh human cadaver hearts. Circulation 61, 77 (1980).

    PubMed  CAS  Google Scholar 

  10. Leisch, F., Herbinger, W., Brücke, P.: Katheterdilatation von Koronararterienstenosen. Zweijährige Erfahrungen. Acta Med. Austriaca 11, 13 (1984).

    PubMed  CAS  Google Scholar 

  11. Levy, R. J., Mock, M. B., Willman, V. L., Passamani, E. R., Frommer, P. L.: Percutaneous transluminal coronary angioplasty—a status report. N. Engl. J. Med. 305, 299 (1981).

    Article  Google Scholar 

  12. Murphy, D. A., Graver, J. M., Jones, E. L., Grüntzig, A. R., King, S. B., Hatcher Jr., C. R.: Surgical revascularisation following unsuccessful percutaneous transluminal coronary angioplasty. J. Thorac. Cardiovasc. Surg. 84, 342 (1982).

    PubMed  CAS  Google Scholar 

  13. Rucker, C. M., Dugall, J. C., Ganter, E. L., Kartub, M. G.: The detection of perioperative myocardial infarction in aortocoronary bypass surgery. Chest 75, 300 (1979).

    Article  PubMed  CAS  Google Scholar 

  14. Sanborn, T. A., Faxon, D. P., Waugh, D., Small, D. M., Haudenschild, C., Gottsman, S. B., Ryan, T. J.: Transluminal angioplasty in experimental atherosclerosis. Analysis for embolisation using an in vivo perfusion system. Circulation 66, 917 (1982).

    PubMed  CAS  Google Scholar 

  15. Schofer, J., Krebber, H. J., bleifeld, W., Mathey, D. G.: Acute coronary occlusion during percutaneous transluminal coronary angioplasty: reopening by intracoronary streptokinase before emergency coronary artery surgery to prevent myocardial infarction. Circulation 66, 917 (1982).

    Google Scholar 

  16. Schwarz, F., Schuler, G., Katus, H., Hofmann, M., Manthey, J., Tillmann, H., Mehmel, H., Kübler, W.: Intracoronary thrombolysis in acute myocardial infarction: duration of ischemia as a major determinant of late results after recanalisation. Am. J. Cardiol. 50, 933 (1982).

    Article  PubMed  CAS  Google Scholar 

  17. Stertzer, S. H.: Transluminal coronary angioplasty—1981. Investigative technique or established procedure? Arch. Intern. Med. 142, 679 (1982).

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Abteilung des Allgemeinen Krankenhauses der Stadt Linz, Krankenhausstraße 9, A-4020, Linz

    F. Leisch & W. Herbinger

  2. I. Chirurgische Abteilung des Allgemeinen Krankenhauses der Stadt Linz, Krankenhausstraße 9, A-4020, Linz

    P. Brücke & C. Gross

  3. Institut für Anästhesie des Allgemeinen Krankenhauses der Stadt Linz, Krankenhausstraße 9, A-4020, Linz

    S. Necek & Bärbel Blaubut

Authors
  1. F. Leisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Herbinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Brücke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Necek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bärbel Blaubut
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leisch, F., Herbinger, W., Brücke, P. et al. Akuter aortokoronarer Bypass nach Koronardilatation . Acta Chir Austriaca 16, 101–107 (1984). https://doi.org/10.1007/BF02656262

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02656262

Schlüsselwōrter

Key-words

Search

Navigation