[Intraoperative circulatory collapse due to a coronary spasm following successful coronary revascularization]

Coronary artery spasm is recognized cause of angina and circulatory collapse during the operative and early postoperative period following cardiopulmonary bypass for coronary artery surgery. We present our experience with hemodynamical collapse during cardiopulmonary bypass weaning, which were refractory to treatment with inotropics such as noradrenaline and adrenalin and vasodilators such as nitroglycerin. The electrocardiographic changes, poor answer to medical treatment following successful cardiopulmonary bypass for coronary artery surgery, good myocardial protection and complete revascularization suggested severe coronary artery spasm. We used sublingual nifedipine, achieving hemodynamical stability and stopping inotropic support and cardiopulmonary bypass. We review the literature about pathophysiologic mechanism and treatment of coronary artery spasm.