Coronary artery spasm after off-pump coronary artery bypass grafting.
BACKGROUND
Coronary artery spasm (CAS) in the immediate postoperative period has been recognized as a possible cause for perioperative myocardial ischaemia after off-pump coronary artery bypass grafting (CABG). It varies in severity and can be associated with circulatory collapse and death. The purpose of this study was to present our experiences on CAS after off-pump CABG and detail its management.


METHODS
The case reports of three patients with similar clinical presentations of ischaemic heart disease who underwent CABG using an off-pump technique are reviewed. Severe manifestations of CAS in the immediate postoperative period with documented angiographic findings are presented.


RESULTS
Three patients (two men and one woman) with angina pectoris were diagnosed with coronary artery disease using coronary angiography. The elective off-pump CABG was uneventful; however, severe manifestation of myocardial ischaemia with abrupt onset developed at the intensive care unit. All three patients underwent immediate coronary angiography to verify the diagnosis of CAS. Apart from intracoronary nitroglycerine infusion and medical support with inotropic agents, extracorporeal membranous oxygenation was carried out because of severe haemodynamic deterioration in one case, while support was required with intraaortic balloon pumping in another. All three patients made a full recovery.


CONCLUSIONS
Coronary artery spasm can severely complicate the postoperative course for patients undergoing off-pump CABG, leading to myocardial ischaemia or infarction, life-threatening arrhythmias, persistent hypotension and even cardiac arrest. Early awareness and diagnosis of CAS with the establishment of appropriate management strategies may prevent its potentially lethal consequences.
Lin
Chih-Yuan
CY
Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan.
Weng
Zen-Chung
ZC
Loh
Shih-Hurng
SH
Hong
Gou-Jieng
GJ
Tsai
Chien-Sung
CS
D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy* / Q000601:surgery* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D003329:Coronary Vasospasm / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged