Present status of coronary artery surgery.

Postinfarction ventricular septal defects are best repaired surgically several weeks after occurrence; however, deterioration of the patient's condition may require emergyncy operation. Ventricular aneurysms are resected when associated with low cardiac output, emboli occur or when present in a patient who is otherwise a candidate for aortocoronary grafting. Mitral valve replacement may be required when coronary disease produces severe malfunction of a papillary muscle or rupture of a chorade tendineae. Acute infarctectomy alone is not recommended at this time. The balloon assist device may result in some patients who are candidates for infarctectomy with aortocoronary bypass graft. Preinfarction angina which is not controlled by medical therapy should be treated by immediate aortocornary bypass. Tachyarrhythmias are not an absolute contraindication to surgery. Stable angina that is unacceptable to the patient under optimal medical therapy and is associated with operable anatomical lesions is the prime indication for coronary artery surgery. Relief of pain and increased exercise tolerance are usual after surgery. Sometimes life may be prolonged.