Focal myocardial ischemic necroses associated with unstable angina pectoris.

Objectives: We sought to determine whether myocardial lesions develop in association with unstable angina pectoris.

Background: We observed a patient with unstable angina pectoris who developed foci of ischemic necroses in the distribution of a single coronary artery. The artery had an atherosclerotic plaque that had undergone ulceration of its fibrous cap.

Delayed death from aortic root trauma.

A 40-year-old man suffered blunt chest trauma, had a myocardial infarct 58 days later, and died unexpectedly 19 days after that. Autopsy showed partial avulsion of a small branch of the right coronary artery with thrombus extending into the right coronary sinus of Valsalva occluding the right coronary artery and causing a myocardial infarct. Death was caused by a thromboembolus arising from the aortic root thrombus and occluding the left main coronary artery.

Gastroduodenal perforation after open heart surgery.

During a thirty month period, 319 patients underwent open heart operations, and of these, three experienced a life-threatening explosive abdominal catastrophe. Aggressive radiographic maneuvers established the diagnosis of gastroduodenal perforation. Appropriate abdominal surgery with plication of the perforation and, whenever possible, the establishment of tube gastrostomy for decompression and a tube jejunostomy for feeding is desirable.