Diffuse Coronary Vasospasm After Zone 2 Debranching and Antegrade TEVAR.

Area of Science:

• Cardiology
• Vascular Surgery
• Cardiovascular Research

Background:

• Coronary vasospasm, the constriction of coronary arteries, is typically observed after coronary artery manipulation like stenting or bypass grafting.
• Thoracic endovascular aortic repair (TEVAR) is a common procedure for aortic pathologies.
• The frozen elephant trunk (FET) procedure is a complex surgical technique used in TEVAR for extensive aortic arch disease.

Observation:

• A 57-year-old man developed diffuse coronary vasospasm postoperatively after undergoing a frozen elephant trunk procedure for an endoleak following TEVAR.
• Cardiac catheterization confirmed the presence of coronary vasospasm before and after treatment.
• The patient required venoarterial extracorporeal membrane oxygenation (VA-ECMO) for hemodynamic support.

Findings:

• Diffuse coronary vasospasm is an uncommon complication that can arise after major aortic surgery, including the frozen elephant trunk procedure.
• The vasospasm was successfully managed, leading to complete recovery of cardiac function within a week.
• This case demonstrates the potential for coronary vasospasm in the context of aortic interventions beyond direct coronary artery procedures.

Implications:

• Highlights the importance of considering coronary vasospasm in patients presenting with cardiac symptoms after aortic surgery.
• Suggests that aortic procedures, even without direct coronary manipulation, can precipitate coronary vasospasm.
• Underscores the efficacy of medical management and hemodynamic support (like VA-ECMO) in treating this rare complication.