[A case of intraoperative repeated coronary artery spasm with ST-segment depression]

A 68-year-old man with good left ventricular function underwent subtotal gastrectomy for gastric cancer under general anesthesia. Twenty minutes after the start of surgery, ST-segment depression was noted on the electrocardiogram monitor without change in the hemodynamic state. Intravenous isosorbide dinitrate relieved the electrocardiographic signs of ischemia. Short episodes of the ST-segment depression recurred 5 times despite intravenous isosorbide dinitrate and nicorandil. Echocardiography immediately after the surgery revealed hypokinesia of the anterior, septal and apical segments with an ejection fraction of 48%, suggesting acute myocardial infarction or the "Takotsubo"-shaped cardiomyopathy. However, a day after surgery, echocardiography showed improvement of regional wall motion with an ejection fraction of 57%. Coronary angiography showed normal coronary arteries on the 22nd day after the surgery. Patient manifested occlusive coronary artery spasm on ergonovine provocative test. We would like to stress that perioperative coronary artery spasm may demonstrate ST-segment depression and may result in severe consequences, regressive but relatively prolonged, in left ventricular function.