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Coronary artery spasm during coronary artery bypass surgery: its diagnosis, treatment and prevention
K Fuse1, H Makuuchi, T Konishi
1Division of Cardiovascular Surgery and Cardiology, Toranomon Hospital, Tokyo, Japan.
Insights
Early diagnosis of coronary artery spasm after myocardial revascularization is possible by monitoring ST-segment changes and graft flows. Nitroglycerin treats spasm, while diltiazem prevents it.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure for myocardial revascularization.
- Postoperative complications can include coronary artery spasm, leading to hemodynamic instability.
Observation:
- Four cases of hemodynamic collapse with ST-segment depression post-cardiopulmonary bypass were observed.
- Low bypass graft flows correlated with these collapse episodes.
Findings:
- Direct nitroglycerin infusion into grafts successfully treated spasm, restoring graft flow and ECG parameters.
- Post-1984 use of diltiazem in cardioplegia and infusions eliminated observed coronary artery spasm.
Implications:
- Monitoring ST-segment changes and graft flow aids early diagnosis of post-revascularization coronary artery spasm.
- Nitroglycerin is an effective treatment for acute spasm, while diltiazem serves as a preventative measure.
Abstract:
Between 1982 and 1983, we experienced four cases of hemodynamic collapse accompanied by an ST-segment depression in the ECG lead II, shortly after the cessation of cardiopulmonary bypass. The bypass graft flows monitored in these patients during the hemodynamic collapse episodes were remarkably low. In three cases, nitroglycerin (0.5-1 mg) was injected directly into the vein graft, which increased the graft flow suddenly, returned the ST-segment to the baseline, and improved the circulatory condition. Since 1984, however, diltiazem has been used in the cardioplegic solution and postoperative drip infusion. Due to the introduction of this drug, coronary artery spasm has not been seen in any of our patients since. These findings show that the monitoring of ST-segment changes and bypass graft flows are useful in the early diagnosis of coronary artery spasm after myocardial revascularization. Direct infusion of nitroglycerin into the vein graft is effective for the treatment of spasm, while diltiazem is useful in the prevention of coronary artery spasm incidental to myocardial revascularization.