[Severe coronary artery spasm immediately after aortic valve replacement].
We report a case of 72-year-old man with severe manifestations of coronary artery spasm immediately after aortic valve replacement (AVR), which was associated with hemodynamic and arrhythmic instability. The AVR was performed under mild hypothermic cardiopulmonary bypass (34 degrees C), and retrograde blood cardioplegia was intermittently delivered at the same temperature. Immediately after the operation, the patient suddenly developed severe bradycardia and hypotension, and repeated ventricular fibrillation. Percutaneous cardiopulmonary support system (PCPS) and intra-aortic balloon pumping (IABP) were required for this circulatory collapse. Echocardiography revealed left ventricular segmental dysfunction, and coronary artery bypass grafting (CABG) to the right coronary artery and the left ascending artery was performed [during CABG, coronary spasm was strongly suspected by repetitive ST elevation and depression on electrocardiogram (ECG) monitor]. Eventually, the spasm subsided with the intravenous infusion of nitrates, nicorandil, and diltiazem. The remaining postoperative course was uneventful and the patient was discharged on the 24th postoperative day in good clinical condition.
Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Sadanari
S
Sawaki
Akio
A
Matsuura
Hideki
H
Ito
Shunei
S
Saito
Haruki
H
Takemura
Ken
K
Miyahara
Shinichi
S
Ashida
Shunsuke
S
Mori
Akira
A
Takanohashi
Kei
K
Yagami
Masato
M
Usui
Yuuichi
Y
Hirate
D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D003329:Coronary Vasospasm / Q000209:etiology* / Q000628:therapy; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011183:Postoperative Complications