Circulation, Vol 56, 906-913, Copyright © 1977 by American Heart Association
BH Bulkely and GM Hutchins
Myocardial infarction after coronary artery bypass graft (CABG) surgery has
been described clinically in up to 30% of patients but there is little
morphologic information about the character and pathogenesis of the
myocardial injury. We studied myocardium in the distribution of bypassed
and nonbypassed coronary arteries for the presence of contraction band
necrosis as compared to coagulation necrosis, in 58 autopsied patients who
died less than 1 month after surgery. Operation related necrosis consisting
of focal subendocardial contraction band necrosis was present to some
degree in 48 (83%) patients. Regional transmural necrosis was present in 22
(38%) patients and was of two types. Contraction band necrosis occurred in
18 patients and was in the distribution of a patent bypassed coronary
artery in 15 of them. Coagulation necrosis was found in four patients, and
in each was in the distribution of a new graft-releated coronary artery
occlusion. The results suggest that coronary artery reflow through widely
patent grafts following the period of operative nonperfusion, rather than
graft or intrinsic coronary artery occlusion, accounts for the majority of
operation-related myocardial "infarcts" associated with CABG surgery. Thus,
prevention of intraoperative myocardial injury must also focus on
characteristics of the phase of myocardial reperfusion.
ARTICLES
Myocardial consequences of coronary artery bypass graft surgery. The paradox of necrosis in areas of revascularization
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