Coronary Artery Vasospasm After Mechanical Aortic Valve Replacement: A Case Report

Coronary artery vasospasm is a rare but fatal postoperative complication of cardiothoracic surgery. This phenomenon can occur directly after surgery or several hours postoperatively. Most reported cases have occurred after CABG surgery and less commonly after valve replacement. Patients can present with various symptoms, and physicians must be familiar with the indications to suspect coronary artery vasospasm to avoid adverse outcomes. We present a case of a 60-year-old female who suffered a cardiac arrest with refractory ventricular fibrillation due to coronary artery vasospasm following aortic valve replacement. During resuscitation, she underwent central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation for hemodynamic support. She subsequently underwent urgent left heart catheterization, revealing vasospasm of the left anterior descending artery, early first diagonal, early first obtuse marginal, and non-dominant right coronary artery. Vasospasm was successfully treated with intracoronary nitroglycerin and nicardipine. This case report demonstrates the importance of early consideration of coronary artery vasospasm as a cause of postoperative arrest following cardiac surgery.