[Clinical evaluation of perioperative myocardial infarction as a complication of valve replacement].

Perioperative myocardial infarction (PMI) is a well-known complication of coronary artery surgery, but rarely encountered in valvular surgery. We have experienced 6 cases of valve replacement with PMI, using blood cardioplegia since 1979. Those patients (5 men, one woman; mean age 47 +/- 8 years) had no previous angina, and preoperative CAG revealed no significant stenosis. Three patients were reoperative cases. A diagnosis of PMI was established by the following criteria; an abnormal increase in maxCPK-MB (greater than 150 IU/l), new Q waves at ECG, positive 99mTc-PYP scan (grade 3-4). The area of PMI was inferior in 4 patients, posterior in one, and anterior infarction was seen in only one case. Three cases required IABP, but all 6 cases showed good exercise capacity by Treadmill exercise test in late stage. Several factors are thought to be the cause of PMI at valvular surgery; such as coronary air embolism, perioperative coronary spasm, inappropriate topical hypothermia, etc. Prognosis is not necessarily poor, however much attention should be paid to prevent PMI in valve replacement.