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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Refractory diffuse coronary artery spasm post aortic valve replacement

Ayako Nagasawa1, Shuichi Okonogi1, Satoshi Ohki1

  • 1Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan.

Interdisciplinary Cardiovascular and Thoracic Surgery
|February 21, 2023
PubMed

Insights

Postoperative coronary artery spasm is a rare complication after valve replacement. This case highlights a fatal instance refractory to prompt intracoronary vasodilator therapy, emphasizing the need for further research into such critical cardiac events.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Vascular Medicine

Background:

  • Postoperative coronary artery spasm is an infrequent complication following cardiac valve replacement surgery.
  • This condition can lead to significant hemodynamic instability and myocardial ischemia.

Purpose of the Study:

  • To report a rare case of refractory coronary artery spasm after aortic valve replacement.
  • To discuss the management and outcome of this critical postoperative complication.

Main Methods:

  • A 64-year-old male patient underwent aortic valve replacement.
  • Following surgery, the patient developed hypotension and ST-segment elevation, indicative of coronary artery spasm.
  • Coronary angiography revealed diffuse three-vessel coronary artery spasm.
  • Intracoronary infusion of vasodilators (isosorbide nitrate, nicorandil, sodium nitroprusside hydrate) was administered promptly.

Main Results:

  • Despite rapid intracoronary vasodilator therapy, the coronary artery spasm was refractory to treatment.
  • The patient experienced persistent low cardiac function and subsequently developed pneumonia.
  • The patient ultimately died due to complications arising from prolonged low cardiac function and pneumonia.

Conclusions:

  • While prompt intracoronary vasodilator infusion is generally considered effective for coronary artery spasm, this case demonstrates a refractory presentation.
  • This case underscores the potential for severe, untreatable outcomes even with aggressive therapeutic interventions for postoperative coronary artery spasm.
  • Further investigation into the mechanisms and management strategies for refractory coronary artery spasm post-valve replacement is warranted.

Keywords:
Aortic valve replacementCoronary spasmPerioperative myocardial infarction

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