Forty patients who came to necropsy over a period of five years due to myocardial damage sustained during cardiac valve replacements were studied. The clinical presentation of myocardial damage was assessed in relation to the preoperative cardiac status. The cause and nature of myocardial damage were assessed at necropsy. Evidence of clinical, electrocardiographic and aortographic coronary atheroma was correlated with distribution at necropsy, and the value of selective coronary angiography in perfusing the coronary arteries during cardiopulmonary bypass is stressed. The causes of myocardial damage could be classified as (a) thrombo-embolic, (b) iatrogenic damage to the coronary arteries, and (c) poor or absent coronary perfusion during cardiopulmonary bypass. A case is made for the importance of coronary perfusion during cardiopulmonary bypass.
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