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Coronary Artery Vasospasm After Mechanical Aortic Valve Replacement: A Case Report
Elen Mussie1, Natalie DeWitte2, Michael Goulet3
1Department of Radiology, Lewis Katz School of Medicine at Temple University, Temple University Hospital, Philadelphia, USA.
Cureus
|January 1, 2024
Summary
Coronary artery vasospasm is a rare, fatal complication after heart surgery. Prompt diagnosis and treatment with medications like nitroglycerin are crucial for patient survival.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Coronary artery vasospasm is a rare but potentially fatal postoperative complication following cardiothoracic surgery.
- It can manifest immediately after surgery or several hours later, often occurring after Coronary Artery Bypass Grafting (CABG) and less commonly after valve replacement procedures.
Observation:
- A case report details a 60-year-old female experiencing cardiac arrest with refractory ventricular fibrillation post-aortic valve replacement.
- Hemodynamic support was initiated with central veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during resuscitation.
Findings:
- Urgent left heart catheterization revealed significant vasospasm in the left anterior descending artery, early first diagonal, early first obtuse marginal, and the non-dominant right coronary artery.
- Intracoronary administration of nitroglycerin and nicardipine successfully resolved the vasospasm.
Implications:
- This case underscores the critical need for early recognition of coronary artery vasospasm in patients presenting with postoperative arrest after cardiac surgery.
- Familiarity with the diagnostic indications and prompt treatment of coronary artery vasospasm can prevent adverse outcomes and improve patient prognosis.
