Surgical Therapy for Acute Congestive Heart Failure

  • Eli Milgalter
  • Davis C. Drinkwater
  • Hillel Laks


Acute left ventricular failure is an ominous state that demands immediate therapy. Without intervention, mortality of patients in cardiogenic shock (CS) exceeds 90%.1 The three major causes of acute ventricular failure are coronary artery disease, severe valvar malfunction, and primary myocardial disease. All three causes require pharmacologic support, occasionally progressing to mechanical support devices. Emergency surgery must be considered early in those cases where the primary cause can be corrected by a surgical procedure.


Mitral Valve Infective Endocarditis Cardiogenic Shock Tricuspid Valve Ventricular Septal Defect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Balooki H. Emergency cardiac procedures in patients in cardiogenic shock due to complications of coronary artery disease. Circulation. 1989;79(Suppl I):I–137–148.Google Scholar
  2. 2.
    Killip T III, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients. Am J Cardiol. 1967;20:457–464.PubMedCrossRefGoogle Scholar
  3. 3.
    Alonso DR, Scheidt S, Post M, Killip T. Pathophysiology of cardiogenic shock: quantification of myocardial necrosis, clinical, pathologic, and electrocardiographic correlations. Circulation. 1973;48:588–596.PubMedGoogle Scholar
  4. 4.
    Page DL, Caulfield JB, Kastor JA, DeSanctis R, Sanders CA. Myocardial changes associated with cardiogenic shock. N Engl J Med. 1971;285:133–137.PubMedCrossRefGoogle Scholar
  5. 5.
    Balooki H. Classification of cardiogenic shock. In Balooki H, ed. Clinical Application of Intra-aortic Balloon Pump. Mt. Kisco, NY: Futura Publishing; 1984:159–170.Google Scholar
  6. 6.
    Guyton RA, Arcidi JM Jr, Langford DA, Morris DC, Liberman HA, Hatcher CR Jr. Emergency coronary bypass for cardiogenic shock. Circulation. 1987;76(Suppl V):V–22–27.Google Scholar
  7. 7.
    Beyersdorf F, Acar C, Buckberg GD, et al. Studies on prolonged regional ischemia. III. Early natural history of simulated single and multivessel disease with emphasis on remote myocardium. J Thorac Cardiovasc Surg. 1989; 98:368–380.PubMedGoogle Scholar
  8. 8.
    Beyersdorf F, Acar C, Buckberg GD, et al. Studies on prolonged acute regional ischemia. IV. Aggressive surgical treatment for intractable ventricular fibrillation after acute myocardial infarction. J Thorac Cardiovasc Surg. 1989;98:557–566.PubMedGoogle Scholar
  9. 9.
    Pennington DG. Emergency management of cardiogenic shock. Circulation. 1989;79(Suppl I):I–149–151.Google Scholar
  10. 10.
    Allen BS, Rosenkranz E, Buckberg GD, et al. Myocardial infarction with left ventricular power failure: a medical/surgical emergency requiring urgent revascularization with maximal protection of remote muscle. J Thorac Cardiovasc Surg. 1989;98:691–703.PubMedGoogle Scholar
  11. 11.
    Pennington DG, Golding L, Hill JD, et al. Temporary mechanical support for cardiogenic shock. Trans Am Soc Artif Intern Organs. 186;32:629–632.Google Scholar
  12. 12.
    Drinkwater DC, Laks H, Buckberg GD. A new simplified method of optimizing cardioplegic delivery without right heart isolation: antegrade/retrograde blood cardioplegia. J Thorac Cardiovasc Surg. 1990;100(1):56–64.PubMedGoogle Scholar
  13. 13.
    Bates RJ, Beutler S, Resnekov L, Agnostopoulos CE. Cardiac rupture-challenge in diagnosis and management. Am J Cardiol. 1977;40:429–437.PubMedCrossRefGoogle Scholar
  14. 14.
    Vlodaver Z, Coe JI, Edwards JE. True and false left ventricular aneurysms: propensity for the latter to rupture. Circulation. 1975;51:567–572.PubMedGoogle Scholar
  15. 15.
    Milgalter E, Uretzky G, Levy P, Borman JB, Appelbaum A. Pseudoaneurysms of the left ventricle. Thorac Cardiovasc Surg. 1987;35:20–25.PubMedCrossRefGoogle Scholar
  16. 16.
    Hill D, Lary D, Kerth W, Gerbode R. Acquired ventricular septal defects. J Thorac Cardiovasc Surg. 1975;70:444.Google Scholar
  17. 17.
    Kitamura S, Mendez A, Kay JH. Ventricular septal defect following myocardial infarction: experience with surgical repair through a left ventriculotomy and review of the literature. J Thorac Cardiovasc Surg. 1971;61:186.Google Scholar
  18. 18.
    Sanders RJ, Kern WH, Blount SG. Perforation of the interventricular septum complicating myocardial infarction. Am Heart J. 1956;51:736.PubMedCrossRefGoogle Scholar
  19. 19.
    Heitmiller R, Jacobs ML, Daggett WM. Surgical management of post infarction ventricular septal rupture. Ann Thorac Surg. 1986;41:683.PubMedCrossRefGoogle Scholar
  20. 20.
    Cooley DA, Belmonte BA, Zeis LB, Schnur S. Surgical repair of ruptured interventricular septum following acute myocardial infarction. Surgery. 1957;41:930.PubMedGoogle Scholar
  21. 21.
    Kirklin JW, Barratt-Boyes BG, ed. Cardiac Surgery. New York: John Wiley and Sons; 1986;311–319.Google Scholar
  22. 22.
    Nishimura RA, Schaff HV, Shub C, Girsh BJ, Edwards WE, Tajik AJ. Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients. Am J Cardiol. 1983;51:373.PubMedCrossRefGoogle Scholar
  23. 23.
    Zamora JL, Burdine JT, Karlberg H, Shenaq SM, Noon GP. Cardiac surgery in patients with end-stage renal disease. Ann Thorac Surg. 1986;42(1):113–117.PubMedCrossRefGoogle Scholar
  24. 24.
    David TE, Bos J, Christakis GT, Brofman PR, Wong D, Feindel CM. Heart valve operations in patients with active infective endocarditis. Ann Thorac Surg. 1990; 49(5):701–705.PubMedCrossRefGoogle Scholar
  25. 25.
    Komshian SV, Tablan OC, Palutke W, Reyes MP. Characteristics of left sided endocarditis caused by Pseudomonas aeruginosa in the Detroit Medical Center. Rev Infect Dis. 1990;12(4):693–702.PubMedCrossRefGoogle Scholar
  26. 26.
    Pringle SD, McCartney AC, Marshall DA, Cobbe SM. Infective endocarditis caused by streptococcus agalactiae. Int J Cardiol. 1989;24(2):179–183.PubMedCrossRefGoogle Scholar
  27. 27.
    Kawamoto T, Nakano S, Matsudo H, Hirose H, Kawashima Y. Candida endocarditis with saddle embolism: a sucessful surgical intervention. Ann Thorac Surg. 1989;5:723–724.CrossRefGoogle Scholar
  28. 28.
    Maderazo EG, Hickingbotham N, Cooper B, Murcia A. Aspergillus endocarditis: cure without surgical valve replacement. South Med J. 1990;83(3):351–352.PubMedCrossRefGoogle Scholar
  29. 29.
    Powderly WG, Stanley SL, Medoff G. Pneumococcal endocarditis: report of a series and review of the literature. Rev Infect Dis. 1986;8(5):786–791.PubMedCrossRefGoogle Scholar
  30. 30.
    Burstein H, Sampson MB, Kohler JP, Levitsky S. Gonococcal endocarditis during pregnancy: Simultaneous caesarian section and aortic valve surgery. Obstet Gynecol. 1985;66(Suppl 3):485–519.Google Scholar
  31. 31.
    al-Harthi SS. The morbidity and mortality pattern of Brucella endocarditis. IntJ Cardiol. 1989;25(3):321–324.CrossRefGoogle Scholar
  32. 32.
    Rumisek JD, Albus RA, Clarke JS. Late mycobacterium chelonel bioprosthetic valve endocarditis: activation of implanted containment. Ann Thorac Surg. 1985;39(3): 277–279.PubMedCrossRefGoogle Scholar
  33. 33.
    Frater RW, Sisto D, Condit D. Cardiac surgery in human immunodeficiency virus (HIV) carriers. Eur J Cardiothorac Surg. 1989;3(2):146–150.PubMedCrossRefGoogle Scholar
  34. 34.
    Sheiban I, Casarotto D, Trevi G, et al. Two-dimensional echocardiography in the diagnosis of intracardiac masses: a prospective study with anatomic validation. Cardiovasc Intervent Radiol. 1987;10(3):157–161.PubMedCrossRefGoogle Scholar
  35. 35.
    Jaffe WM, Morgan DE, Pearlman AS, Otto CM. Infective endocarditis, 1983–1988: echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol. 1990;15(6): 1227–1233.PubMedCrossRefGoogle Scholar
  36. 36.
    Popp RL. Medical progress—echocardiography. N Engl J Med. 1990;323(3):165–172.PubMedCrossRefGoogle Scholar
  37. 37.
    McCartney AC, Orange GV, Pringle SD, Wills G, Reece IJ. Serum C reactive protein in infective endocarditis. J Clin Pathol. 1988;41(1):44–48.PubMedCrossRefGoogle Scholar
  38. 38.
    Akins EW, Limacher M, Sloan RM, Hill JA. Evaluation of an aortic annular pseudoaneurysm by MRI: comparison with echocardiography, angiography, and surgery. Cardiovasc Intervent Radiol. 1987;10(4):188–193.PubMedCrossRefGoogle Scholar
  39. 39.
    Ting W, Silverman NA, Arzouman DA, Levitsky S. Splenic septic emboli in endocarditis. Circulation. 1990;82(Suppl 5):IV105–109.PubMedGoogle Scholar
  40. 40.
    Karl T, Wensley D, Stark J, De Leval M, Rees P, Taylor JFN. Infective endocarditis in children with congenital heart disease: comparison of selected features in patients with surgical correction or palliation and those without. Br Heart J. 1987;58:57–65.PubMedCrossRefGoogle Scholar
  41. 41.
    Alsip SG, Blackstone EH, Kirkilin JW, Cobbs CG. Indications for cardiac surgery in patients with active infective endocarditis. Am J Med. 1985;78(6B):138–148.PubMedCrossRefGoogle Scholar
  42. 42.
    Agostino RS, Miller DC, Stinson EB, et al. Valve replacement in patients with native valve endocarditis: what really determines operative outcome? Ann Thorac Surg. 1985;40(5):429–438.PubMedCrossRefGoogle Scholar
  43. 43.
    Soyer R, Redonnet M, Bessou JP, Mutel P, Hubscher C, Letac B. Valve replacement in acute native valve endocarditis. Thorac Cardiovasc Surg. 1986;34(3):149–152.PubMedCrossRefGoogle Scholar
  44. 44.
    Tuna IC, Orszulak TA, Schaff HV, Danielson GK. Results of homograft aortic valve replacement for active endocarditis. Ann Thorac Surg. 1990;49(4):619–624.PubMedCrossRefGoogle Scholar
  45. 45.
    Zwischenberger JB, Shalaby TZ, Conti VR. Viable cryopreserved aortic homograft for aortic valve endocarditis and annular abscesses. Ann Thorac Surg. 1989;48(3):364–369.CrossRefGoogle Scholar
  46. 46.
    Okita Y, Franciosi G, Matsuki D, Robles A, Ross DN. Early and late results of aortic root replacement with antibiotic-sterilized homograft. J Thorac Cardiovasc Surg. 1988;95(4):696–704.PubMedGoogle Scholar
  47. 47.
    DiNubile MJ, Calderwood SB, Steinhaus DM, Karchmer AW. Cardiac conduction abnormalities complicating native valve active infective endocarditis. Am J Cardiol. 1986;58(13):1213–1217.PubMedCrossRefGoogle Scholar
  48. 48.
    David TE, Komeda M, Brofman PR. Surgical treatment of aortic root abscess. Circulation. 1989;80:1269–1274.CrossRefGoogle Scholar
  49. 49.
    Fiore AC, Ivey TD, McKeown PP, Misbach GA, Allen MD, Dillard DH. Patch closure of aortic annulus mycotic aneurysms. Ann Thorac Surg. 1986;42:372–379.PubMedCrossRefGoogle Scholar
  50. 50.
    Shaffer EM, Snider AR, Beekman RH, Behrendt DM, Peschiera AW. Sinus of valsalva aneurysm complicating bacterial endocarditis in an infant: diagnosis with two-dimensional and doppler echocardiography. J Am Cardiol. 1987;9(3):588–591.CrossRefGoogle Scholar
  51. 51.
    Dreyfus G, Serraf A, Jebara VA, et al. Valve repair in acute endocarditis. Ann Thorac Surg. 1990;49(5):706–711.PubMedCrossRefGoogle Scholar
  52. 52.
    Ghosh PK, Miller HI, Vidne BA. Mitral obstruction in bacterial endocarditis. Br Heart J. 1985;53(3):341–344.PubMedCrossRefGoogle Scholar
  53. 53.
    David TE, Feindel CM. Reconstruction of the mitral annulus. Circulation. 1987;76(3 pt 2):III102–107.PubMedGoogle Scholar
  54. 54.
    Fleisher AG, David I, Mogtader A, Hutchinson JE III. Mitral valvuloplasty and repair for infective endocarditis. J Thorac Cardiovasc Surg. 1987;93(2):311–315.PubMedGoogle Scholar
  55. 55.
    Robbins MJ, Soeiro R, Frishman WH, Strom JA. Right-sided valvular endocarditis: etiology, diagnosis, and an approach to therapy. Am Heart J. 1986;111(1):128–135.PubMedCrossRefGoogle Scholar
  56. 56.
    Chan P, Ogilby JD, Segal B. Tricuspid valve endocarditis. Am Heart J. 1989;117(5):1140–1146.PubMedCrossRefGoogle Scholar
  57. 57.
    Dressier FA, Roberts WC. Infective endocarditis in opiate addicts: analysis of 80 cases studied at necropsy. Am J Cardiol. 1989;117(5):1140–1146.Google Scholar
  58. 58.
    Mammana RB, Levitsky S, Sernaque D, Beckman CB, Silverman NA. Valve replacement for left-sided endocarditis in drug addicts. Ann Thorac Surg. 1989;35(4):436–441.CrossRefGoogle Scholar
  59. 59.
    Yee ES, Khonsari S. Right-sided infective endocarditis: valvuloplasty, valvectomy, or replacement. J Cardiovasc Surg. 1989;30(5):744–748.Google Scholar
  60. 60.
    Hughs CF, Noble N. Vegetectomy, an alternative surgical treatment for infective endocarditis of the atrioventricular valves in drug addicts. J Thorac Cardiovasc Surg. 1988;95(5):857–861.Google Scholar
  61. 61.
    Louie EK, Bieniarz T, Moore AM, Levitsky S. Reduced atrial contribution to left ventricular filling in patients with severe tricuspid regurgitation after tricuspid valvulectomy: a doppler echocardiographic study. J Am Coll Cardiol. 1990;16(7):1617–1624.PubMedCrossRefGoogle Scholar
  62. 62.
    Stern HJ, Sisto DA, Strom JA, Soeiro R, Jones SR, Frater RW. Immediate tricuspid valve replacement for endocarditis: indications and results. J Thorac Cardiovasc Surg. 1986;91(2):163–167.PubMedGoogle Scholar
  63. 63.
    Arbulu A, Asfaw I. Management of infective endocarditis: seventeen years’ experience. Ann Thorac Surg. 1987;43(2):144–149.PubMedCrossRefGoogle Scholar
  64. 64.
    Lewis JF, Peniston RL, Randall OS, Spencer J, Sheller LM. Tricuspid stenosis in prosthetic valve endocarditis. Diagnosis by doppler echocardiography. Chest. 1987; 91(2):276–277.PubMedCrossRefGoogle Scholar
  65. 65.
    Schulte HD, Horstkotte D, Evagelopoulos N, Bircks W, Loogen F. Reoperations for malfunction of heart valve prostheses, especially with endocarditis. Thorac Cardiovasc Surg. 1987;35(1):16–19.PubMedCrossRefGoogle Scholar
  66. 66.
    Rochiccioli C, Chastre J, Lecompte Y, Gandjbakhch I, Gilbert C. Prosthetic valve endocarditis: the case for prompt surgical managment. J Thorac Cardiovasc Surg. 1986;92(4):784–789.Google Scholar
  67. 67.
    Cowgill LD, Addonizio VP, Hopeman AR, Harken AH. A practical approach to prosthetic valve endocarditis. Ann Thorac Surg. 1987;43(4):450–457.PubMedCrossRefGoogle Scholar
  68. 68.
    Armitage JM, Hardesty RL, Griffith BP. Prostaglandin E1: an effective treatment of right heart failure after orthotopic heart transplantation. J Heart Transplant. 1987;6;348–351.PubMedGoogle Scholar
  69. 69.
    Gilbert EM, Dewitt CW, Eiswirth CC, et al. Treatment of refractory cardiac allograft rejection with OKT3 monoclonal antibody. Am J Med. 1987;82:202.PubMedCrossRefGoogle Scholar
  70. 70.
    Trento A, Hardesty RL, Griffith BP, et al. Role of the antibody to vascular endothelial cells in hyperacute rejection in patients undergoing cardiac transplantation. J Thorac Cardiovasc Surg. 1988;95:37–41.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 1994

Authors and Affiliations

  • Eli Milgalter
  • Davis C. Drinkwater
  • Hillel Laks

There are no affiliations available

Personalised recommendations