Forensic Consideration of Myocardial Reperfusion Injury Associated with Cardiac Valves Replacement and Coronary Artery Bypass Graft: A Case Report.

Korean J Leg Med. 2005 Oct;29(2):146-151. Korean.

Department of Forensic Medicine, National Institute of Scientific Investigation, Korea. x347@wonju.yonsei.ac.kr

The most effective ways to salvage ischemic myocardium threatened by infarction is to restore tissue perfusion as rapidly as possible. These are best accomplished by restoration of coronary flow(reperfusion) by thrombolysis, percutaneous transluminal conronary angioplasty(PTCA), coronary arterial bypass graft (CABG), or cardiac transplantation. Reperfusion of an ischemic area may result however, in paradoxical cardiomyocytes dysfunction, a phenomenon termed" reperfusion injury". Reperfusion injury has been observed in each of above situations. The myocardium can tolerate brief periods (up to 15 minutes) of severe and even total myocardial ischemia without resultant myocardial death. With increasing duration and severity of ischemia, greater cardiomyocytes damage develop with spectrum of reperfusion associated pathologies, collectively called reperfusion injury. Here, we report a case of a sixty two-year-old female woman who was suffered cardiac surgery(bivalvular replacement and CABG) and died soon after. Post-mortem examination have revealed typical cardiac reperfusion injury in the background of diffuse myocardial infarction. So, authors report this case with literatures reviews, because we think that this is very good case of cardiac reperfusion injury, confirmed histologically by post-mortem examination.

Key Words : Reperfusion injury, Heart, Ischemia, Autopsy