[Severe Coronary Artery Spasm after Coronary Artery Bypass Grafting;Report of a Case]

Area of Science:

• Cardiology
• Vascular Surgery

Background:

• Coronary artery spasm following coronary artery bypass grafting (CABG) is a rare, potentially fatal complication.
• Established treatments for perioperative coronary spasm are lacking due to its rarity and poorly understood mechanisms.

Observation:

• A 67-year-old male experienced perioperative spasm in native coronary arteries and a left thoracic artery graft after CABG.
• Intracoronary isosorbide sulfate injections provided incomplete relief of the spasm.

Findings:

• The patient required 5 days of intra-aortic balloon pumping for circulatory support.
• Post-treatment, cardiac function improved, and the patient recovered.
• Echocardiography revealed reduced left ventricular systolic function with apical akinesis; angiography confirmed graft patency.

Implications:

• This case suggests circulatory support may be a viable strategy for managing refractory perioperative coronary artery spasm post-CABG.
• Further research is needed to understand the pathophysiology and optimize treatment for this rare complication.