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Vasodilator resistant lethal spasm after uncomplicated off-pump coronary surgery
Tetsuya Ueno1, Kazuyuki Ikeda, Atsushi Nakashima
1Department of Thoracic & Cardiovascular Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima 890-8520, Japan. tueno@m.kufm.kagoshima-u.ac.jp
Asian Cardiovascular & Thoracic Annals
|March 23, 2006
Summary
A rare case of lethal coronary artery spasm occurred after coronary artery bypass grafting surgery, even without typical risk factors. Vasodilator treatments were ineffective, leading to fatal cardiogenic shock and organ failure.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Medicine
Background:
- Off-pump coronary artery bypass grafting (OPCABG) is a standard procedure for coronary artery disease.
- Coronary artery spasm is a potential complication, though rare after OPCABG.
Observation:
- A patient developed lethal coronary artery spasm post-OPCABG despite an uncomplicated surgery.
- The patient had no significant predisposing factors for spasm, except for a history of smoking.
- Intracoronary vasodilators administered via transcatheter injection failed to resolve the spasm.
Findings:
- The refractory coronary artery spasm led to extensive acute myocardial infarction.
- The patient experienced profound cardiogenic shock.
- The condition progressed to multiple organ failure and death.
Implications:
- This case highlights a rare but devastating complication of OPCABG.
- It underscores the potential for severe coronary artery spasm even in seemingly low-risk patients.
- The refractoriness to vasodilators suggests alternative mechanisms or management strategies may be needed.