title: Refractory vascular spasm associated with coronary bypass grafting.
abstract: Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Inha University Hospital.
authors.forename: Young Sam
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Inha University Hospital.
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Yoon
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Inha University Hospital.
authors.forename: Jeoung Taek
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology, Inha University Hospital.
authors.forename: Helen Ki
authors.initials: HK
authors.lastname: Shinn
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital.
authors.forename: Seong Ill
authors.initials: SI
authors.lastname: Woo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Inha University Hospital.
authors.forename: Wan Ki
authors.initials: WK
authors.lastname: Baek
keywords: Coronary artery bypass; Coronary vasospasm