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Updated: Jun 16, 2026
06:39
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
[Severe coronary artery spasm immediately after aortic valve replacement]
Sadanari Sawaki1, Akio Matsuura, Hideki Ito
1Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|February 10, 2010
Summary
Aortic valve replacement can trigger severe coronary artery spasm, leading to circulatory collapse. Prompt treatment with vasodilators and circulatory support resolved the spasm and stabilized the patient.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Intensive Care Medicine
Background:
- Coronary artery spasm is a potential complication following cardiac surgery.
- Aortic valve replacement (AVR) can precipitate severe cardiovascular events.
- Hemodynamic and arrhythmic instability pose significant risks post-cardiac procedures.
Observation:
- A 72-year-old male experienced severe coronary artery spasm immediately after AVR.
- The patient developed bradycardia, hypotension, and ventricular fibrillation, requiring percutaneous cardiopulmonary support and intra-aortic balloon pumping.
- Coronary artery bypass grafting revealed suspected spasm with ECG monitoring.
Findings:
- Intravenous nitrates, nicorandil, and diltiazem effectively resolved the coronary artery spasm.
- The patient's postoperative course was uneventful after spasm resolution.
- Successful discharge on the 24th postoperative day was achieved.
Implications:
- This case highlights the critical importance of recognizing and managing coronary artery spasm post-AVR.
- Aggressive vasodilator therapy and circulatory support are crucial for managing such complications.
- Early diagnosis and intervention can lead to favorable patient outcomes after complex cardiac surgery.
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