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Updated: Jun 18, 2026

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Published on: September 17, 2021

[Coronary artery spasm during one-lung ventilation].

Maiko Ishigaki¹, Takuo Hoshi, Makoto Tanaka

¹Department of Anesthesiology, Tsukuba University Hospital, Tsukuba 305-8575.

Masui. the Japanese Journal of Anesthesiology

|November 26, 2009

Summary

Coronary artery spasm occurred during one-lung ventilation in a lung cancer patient. Prompt treatment with nitroglycerin and two-lung ventilation resolved the ST elevation, highlighting the need for vigilance.

Area of Science:

Cardiology
Anesthesiology
Thoracic Surgery

Background:

A 66-year-old male with hypertension and prior cerebral infarction underwent evaluation for lung cancer surgery.
The patient had no prior history or indicators of ischemic heart disease.

Observation:

During induction of general anesthesia and initiation of one-lung ventilation for a right upper lobectomy, significant ST elevation was observed on the ECG.
Surgery was immediately halted, and the patient received nitroglycerin infusion and transitioned to two-lung ventilation, which resolved the ST elevation.

Findings:

Coronary angiography revealed normal coronary arteries, leading to a diagnosis of coronary artery spasm.
Potential triggers identified included increased right ventricular pressure from one-lung ventilation and vagal stimulation from remifentanil.

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Implications:

This case underscores the importance of recognizing coronary artery spasm as a potential complication during thoracic surgery with one-lung ventilation.
Preoperative risk factor assessment, avoidance of identified triggers, and prompt perioperative management are crucial for preventing adverse cardiac events.