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Intractable Left Internal Mammary Artery Spasm After Coronary Artery Bypass Grafting
Vrinda Vyas1, Alisha Khan1, Avneet Singh2
1Internal Medicine, State University of New York (SUNY) Upstate Medical University, Syracuse, USA.
Insights
Graft spasm, a rare complication after coronary artery bypass grafting, can be fatal. This case highlights successful management of severe left internal mammary artery spasm with nitroglycerin, followed by redo bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Vascular Complications
- Surgical Outcomes
Background:
- Graft spasm is a rare but serious complication following coronary artery bypass grafting (CABG).
- Management guidelines for severe graft spasm are not well-established.
- Early diagnosis and prompt treatment are crucial to prevent fatal outcomes.
Observation:
- A 29-year-old male patient experienced left internal mammary artery (LIMA) spasm post-CABG.
- Intracoronary nitroglycerin administration provided temporary relief, confirming the diagnosis of spasm.
- The patient's condition necessitated a redo bypass grafting procedure.
Findings:
- Severe graft spasm can occur in the immediate postoperative period after CABG.
- Intracoronary nitroglycerin can be an effective diagnostic and temporizing treatment for LIMA spasm.
- Redo bypass grafting may be required in cases of persistent or severe graft spasm.
Implications:
- This case underscores the importance of recognizing and managing graft spasm in CABG patients.
- Further research into standardized protocols for severe graft spasm management is warranted.
- Prompt intervention can improve outcomes in patients experiencing this rare complication.
Abstract:
Graft spasm is a rare but well-recognized complication of coronary artery bypass grafting (CABG). The occurrence of graft spam is multifactorial and can be fatal if not diagnosed and treated promptly. There are no well-defined guidelines for the management of a severe spasm. We report the case of a 29-year-old man with left internal mammary artery (LIMA) spasm in the immediate post-operative period following CABG. The intracoronary infusion of nitroglycerin relieved the spasm temporarily, confirming the diagnosis. The patient eventually underwent redo bypass grafting.
