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Coronary artery spasm after Cryo Maze III procedure
Bijoy G Rajbanshi1, Eduardo Rodrigues, James J Lynch
1Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, Minnesota, USA.
The Annals of Thoracic Surgery
|November 5, 2011
Summary
A patient experienced reversible right coronary artery spasm after a Cryo-Maze procedure. This complication, linked to ablation lines near the coronary artery, was successfully treated with nitroglycerin.
Area of Science:
- Cardiovascular Surgery
- Cardiac Ablation Techniques
Background:
- Minimally invasive cardiac ablation, like the Cox Maze III procedure, simplifies atrial fibrillation treatment.
- Tissue ablation devices have improved surgical efficiency but carry recognized risks.
- Concomitant procedures, such as mitral valve repair with Cryo-Maze, are increasingly common.
Observation:
- A 45-year-old woman underwent mitral valve repair and a simultaneous Cryo-Maze procedure.
- Post-operatively, she developed ST-segment elevation, indicative of myocardial ischemia.
- Coronary angiography revealed reversible right coronary artery spasm.
Findings:
- The right coronary artery spasm was directly linked to the proximity of ablation lines on the right atrium.
- Intracoronary nitroglycerin administration effectively reversed the coronary artery spasm.
- This case highlights a specific complication of Cryo-Maze procedures in relation to coronary anatomy.
Implications:
- Awareness of potential coronary artery spasm is crucial for surgeons performing Cryo-Maze procedures.
- Careful consideration of ablation line placement relative to coronary arteries may mitigate this risk.
- Prompt diagnosis and treatment with vasodilators can resolve this complication effectively.
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