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      Refractory Coronary Artery Spasm after Minimally Invasive Direct Coronary Artery Bypass Grafting

      case-report

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          Abstract

          Postoperative coronary arterial spasm is a rare but potentially fatal complication. A 51-year-old male patient with a history of a reactive ergonovine stress test coronary angiogram developed refractory coronary artery spasm after undergoing minimally invasive direct coronary artery bypass grafting of the left anterior descending coronary artery. The patient was successfully managed with rapid implementation of intra-aortic balloon-pump counter pulsation and extracorporeal membrane oxygenation.

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          Usefulness of fasudil, a Rho-kinase inhibitor, to treat intractable severe coronary spasm after coronary artery bypass surgery.

          A Shiose, Takahiro Nishida, Tetsuya Matoba … (2004)
          We have recently demonstrated that fasudil, a Rho-kinase inhibitor, is effective in suppressing coronary artery spasm in patients with vasospastic angina. Thus, blockade of Rho-kinase may provide a novel therapeutic strategy to treat ischemic coronary syndrome caused by the spasm. Severe coronary artery spasm still remains a life-threatening serious complication of coronary artery bypass grafting (CABG). In this study, we examined the inhibitory effect of fasudil in patients with intractable severe coronary spasm after CABG. Three patients who underwent CABG showed severe myocardial ischemia resistant to intensive therapy with intravenous conventional vasodilators, including isosorbide dinitrate (ISDN), diltiazem, and nicorandil. Coronary angiography revealed severe coronary spasm in native coronary arteries and/or bypass arterial grafts in all patients. Since intracoronary and/or intragraft administration of ISDN was ineffective to resolve the spasm, we then administered fasudil (1.5 mg/min for 15 minutes) into the spastic arteries. Fasudil successfully resolved the spasm and improved myocardial ischemia in all patients without any systemic adverse effects. In conclusion, the treatment with fasudil may be useful to treat intractable and otherwise fatal coronary spasm resistant to intensive conventional vasodilator therapy after CABG.
          Article 0 comments Cited 12 times – based on 0 reviews     Review now
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            Coronary artery spasm and ventricular fibrillation after off-pump coronary surgery.

            Hartmuth B Bittner (2001)
            Native coronary artery or bypass graft spasm is a rare cause of acute myocardial infarction after coronary artery bypass grafting. This report presents angiographic documentation of native coronary artery spasm following successful multivessel off-pump coronary revascularization, which caused myocardial ischemia leading to inferior wall myocardial infarction and ventricular fibrillatory arrest.
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              Coronary artery spasm: a rare but important cause of postoperative myocardial infarction.

              L Guo, Richard M. Myers, Nancy L Kuntz (2008)
              Myocardial infarction that is attributed to native coronary artery spasm in the early postoperative phase has rarely been documented. We report three cases of postoperative myocardial infarction secondary to angiographically demonstrated coronary spasm. Native coronary artery spasm is a rare, but important cause of postoperative ischemia and infarction. Suspicious electrocardiographic changes warrant consideration of transesophageal echocardiography to detect unexpected wall motion abnormalities. Established treatments include intravenous or intracoronary infusion of nitroglycerin and calcium channel antagonists, although several new therapeutic agents may also be beneficial. Prompt coronary angiography is the only definitive modality for early diagnosis and targeted treatment.
              Article 0 comments Cited 4 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Thorac Cardiovasc Surg
                Journal ID (iso-abbrev): Korean J Thorac Cardiovasc Surg
                Journal ID (publisher-id): KJTCS
                Title: The Korean Journal of Thoracic and Cardiovascular Surgery
                Publisher: Korean Society for Thoracic and Cardiovascular Surgery
                ISSN (Print): 2233-601X
                ISSN (Electronic): 2093-6516
                Publication date (Print): August 2011
                Publication date (Electronic): 18 August 2011
                Volume: 44
                Issue: 4
                Pages: 288-291
                Affiliations
                [* ]Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
                [** ]Department of Thoracic and Cardiovascular Surgery, Sunchoen St. Carollo Hospital, Korea.
                Author notes
                Corresponding author: Suk-Jung Choo, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. (Tel) 82-2-3010-3954, (Fax) 82-2-3010-6966, sjchoo@ 123456amc.seoul.kr
                Article
                DOI: 10.5090/kjtcs.2011.44.4.288
                PMC ID: 3249322
                PubMed ID: 22263171
                SO-VID: 77e76f2b-3769-46fe-9d84-edbaefc4bcf6
                Copyright © © The Korean Society for Thoracic and Cardiovascular Surgery. 2011. All right reserved.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 December 2010
                Date revision received : 10 April 2011
                Date accepted : 31 May 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: assistive devices,myocardial injury,minimal invasive surgery,coronary artery bypass surgery,vasospasm
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: assistive devices, myocardial injury, minimal invasive surgery, coronary artery bypass surgery, vasospasm

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