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[Coronary artery spasm after aortic valve replacement: a case report].
K Seki1, R Kuribayashi, T Sakurada
1Department of Cardiovascular Surgery, Akita University School of Medicine.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|February 1, 1991
Summary
A patient experienced hemodynamic collapse during aortic valve replacement surgery, later diagnosed as coronary artery spasm. Prompt treatment with vasodilators resolved the issue, highlighting spasm as a risk in cardiac operations.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- A 64-year-old male underwent aortic valve replacement for aortic regurgitation.
- The patient had no prior history of angina or calcium channel blocker use.
Observation:
- Unexpected hemodynamic collapse occurred during the final stages of the aortic valve replacement surgery.
- Initial resuscitation was successful, but recurrent episodes of collapse persisted post-operatively.
- ST-segment elevation on 12-lead electrocardiogram (ECG) confirmed coronary artery spasm on postoperative day 7.
Findings:
- Postoperative coronary arteriography revealed no anatomical coronary artery disease.
- Intraoperative ergonovine testing induced spasm in the right coronary artery, but not the left.
- Continuous administration of calcium channel blockers and coronary vasodilators effectively prevented further episodes.
Implications:
- Perioperative coronary artery spasm is a potential complication during cardiac surgery, not limited to coronary artery bypass grafting.
- Early diagnosis and management with vasodilators are crucial for resolving spasm and preventing recurrence.
- This case underscores the importance of considering coronary artery spasm in patients experiencing unexplained hemodynamic instability during or after cardiac procedures.