Perioperative coronary artery spasm in off-pump coronary artery bypass grafting and its possible relation with perioperative hypomagnesemia.
OBJECTIVE
We experienced 3 cases of serious perioperative coronary artery spasm in off-pump coronary artery bypass grafting (OPCAB). In consideration of the causes, we directed our attention to hypomagnesemia, one of the triggers of coronary artery spasm. This study was performed to confirm the tendency to hypomagnesemia in OPCAB.


METHODS
First, we report 3 patients having severe coronary artery spasm immediately after OPCAB with consideration of the causes. Second, serial magnesium (Mg) value (xylidyl blue method, normal 1.9-3.1 mg/dl) was measured in 45 consecutive patients with OPCAB between April and October 2002, 1) before starting the operation, and 2) after the patient's entrance into the intensive care unit.


RESULTS
Preoperative and postoperative values of Mg (mg/dl) were 2.1+/-0.3, 1.7+/-0.3, respectively (p < 0.01). Postoperative incidence of hypomagnesemia was as high as 89% of the patients (40 out of 45 patients). In this study and thereafter, we corrected hypomagnesemia with magnesium sulfate during and after OPCAB, and no perioperative coronary artery spasm occurred.


CONCLUSIONS
Hypomagnesemia, one of the triggers of coronary artery spasm, is very common in OPCAB. We strongly recommend the correction of hypomagnesemia during and after OPCAB for the prevention of perioperative coronary artery spasm.
Department of Thoracic and Cardiovascular Surgery, Fukuoka Tokushukai Hospital, Fukuoka, Japan.
Naoki
N
Minato
Yuji
Y
Katayama
Masayuki
M
Sakaguchi
Manabu
M
Itoh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000601:surgery; D003329:Coronary Vasospasm / Q000097:blood* / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008274:Magnesium / Q000097:blood*; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D014654:Vascular Patency; D014883:Water-Electrolyte Imbalance / Q000209:etiology* / Q000628:therapy
D002121:Calcium Channel Blockers; D008278:Magnesium Sulfate; D008274:Magnesium