Surgical implications of low cardiac output syndrome after myocardial infarction.

There is a spectrum of conditions that can occur after severe myocardial infarction which cause inadequate cardiac output. Severe and generalized infarction may result in inadequate perfusion of sufficient myocardium to maintain the cardiac work load. Management is limited to supportive measures, including the use of the intraaortic balloon pump. More localized defects of myocardial blood supply can give rise to myocardial rupture. These ruptures may occur in the free wall, within the septum, or within a papillary muscle. Conservative therapy is only indicated as long as improvement continues. Surgical measures should not be delayed in the face of clinical deterioration. They consist of debridement of dead tissue and repair of the defect (or mitral valve replacement if papillary muscle rupture is present).