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Multivessel coronary artery vasospasm masquerading as surgical coronary atherosclerotic disease

Navneet Singh1, Parma Nand1

  • 1Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand.

Journal of Cardiac Surgery
|July 26, 2021
PubMed

Insights

A case of severe coronary vasospasm mimicking obstructive coronary artery disease was successfully treated with thoracic sympathectomy. This intervention managed refractory vasospastic angina, offering a novel therapeutic approach.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Surgical Innovation

Background:

  • A 39-year-old female presented with escalating angina symptoms.
  • Initial assessments suggested obstructive coronary artery disease requiring surgical intervention.

Observation:

  • Coronary angiography revealed significant vasospasm in multiple coronary arteries and bypass grafts, not obstructive disease.
  • The patient experienced cardiac arrest during surgery, necessitating extracorporeal membrane oxygenation (ECMO).

Findings:

  • Severe multivessel coronary vasospasm was diagnosed as the underlying cause of the patient's symptoms.
  • Medical management with calcium channel blockers and bilateral thoracic sympathectomy effectively controlled the vasospasm.

Implications:

  • This case underscores the critical importance of considering coronary vasospasm in angina diagnosis, even with apparent obstructive findings.
  • Thoracic sympathectomy presents a potentially novel and effective treatment for refractory vasospastic angina.
Abstract

Keywords:
cardiovascular pathologycoronary artery disease

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