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[Right coronary spasm immediately after coronary artery bypass grafting for the left coronary artery]
1Department of Thoracic and Cardiovascular Surgery, Yokohama-Sakae Kyosai Hospital.
Insights
Sudden cardiac arrest post-coronary artery bypass grafting was caused by right coronary artery spasm. Prompt intervention including cardiac massage and defibrillation successfully restored rhythm and blood pressure.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure for treating coronary artery disease.
- Postoperative complications can arise, necessitating prompt diagnosis and management.
Observation:
- A 39-year-old male experienced sudden cardiac arrest with ventricular tachycardia immediately after CABG for the left coronary artery.
- Electrocardiogram (ECG) changes indicated right ventricle origin of the arrhythmia.
- Despite medical and electrical interventions, the patient's condition did not improve.
Findings:
- Intraoperative findings revealed adequate flow in the left coronary artery bypass graft but no right ventricle constriction.
- Right coronary artery spasm was diagnosed as the cause of the event.
- Direct cardiac massage and defibrillation applied to the cardiac surface normalized cardiac rhythm and blood pressure.
Implications:
- This case highlights the potential for coronary artery spasm as a rare but critical complication following CABG.
- Timely diagnosis and aggressive management, including direct cardiac intervention, are crucial for patient survival.
- Continuous infusion of nitroglycerin and diltiazem, along with intra-aortic balloon pump (IABP) support, aided recovery and prevented recurrence.
Abstract:
Right coronary spasm immediately after coronary artery bypass grafting for the left coronary artery in a 39-year-old male is described. After the patient was returned to ICU, ECG at leads II, III, and aVF changed suddenly, ventricular tachycardia (right ventricle origin) and cardiac arrest ensured. As neither administration of drug nor application of D.C. was effective. The chest was reopened at ICU. Though there was sufficient flow in the left coronary artery bypass graft flow, the right ventricle did not constrict at all. Right coronary artery spasm was diagnosed, and, upon application of the direct cardiac massage and D.C. at the cardiac surface, cardiac rhythm and blood pressure were normalized. IABP was inserted to improve cardiac function, and the chest was closed. In addition, nitroglycerin and diltiazem were infused continuously. No spasm has occurred after this episode, and the patient has been discharged and is doing well.