Perioperative coronary artery spasm in modified Bentall's operation for annulo-aortic ectasia in Marfan's syndrome. A case report of perioperative chordal rupture of the mitral valve.
We experienced a rare case of Marfan's syndrome with annulo-aortic ectasia, aortic regurgitation and Prinzmetal's variant angina. In a modified Bentall's operation (button technique), perioperative severe coronary artery spasm occurred in spite of the preventive use of nitroglycerin infusion, which resulted in profound ventricular fibrillation and subsequent chordal rupture of the mitral valve with Sellers IV regurgitation. Use of nicardipine contained in cardioplegia, continuous infusion of nicardipine and nitroglycerin after aortic declamping completely prevented coronary spasm throughout the course of a second surgery for mitral valve replacement. It is worthy to report this case because of rarities such as Marfan's syndrome accompanied by Prinzmetal's variant angina, perioperative coronary artery spasm in modified Bentall's operation, and perioperative chordal rupture of the mitral valve and progression of mitral valve regurgitation. We also stress the efficacy of a new calcium antagonist, nicardipine, to prevent coronary artery spasm during open heart surgery.
Minato
N
N
Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Japan.
Itoh
T
T
Natsuaki
M
M
Furukawa
K
K
Rikitake
K
K
Yamamoto
H
H
D000788:Angina Pectoris, Variant / Q000150:complications* / Q000188:drug therapy; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D002815:Chordae Tendineae / Q000473:pathology; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications*; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000209:etiology; D009529:Nicardipine / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology*; D012422:Rupture, Spontaneous
D009529:Nicardipine