Coronary Vasospasm as an Unexpected Cause of Intraoperative Hemodynamic Instability and Cardiac Arrest.
We present a case of intraoperative coronary artery vasospasm during thoracic surgery causing profound hemodynamic instability. A 68-year-old man undergoing completion right pneumonectomy exhibited intraoperative widespread ST elevation with associated hypotension. Transesophageal echocardiography performed by the anesthetist revealed hypokinetic apical and lateral walls, prompting transportation to the catheterization laboratory, with angiography demonstrating widespread coronary artery spasm. Intracoronary nitroglycerin relieved the vasospasm; however, heparin administration caused significant postoperative bleeding, resulting in cardiac arrest requiring resuscitation and return to the operating room. He ultimately recovered and was discharged to a rehabilitation facility 3 weeks later.
Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia. Electronic address: matil.anderson@gmail.com.
Matilda M
MM
Anderson
Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
Julian
J
Gooi
Department of Cardiothoracic Surgery, Alfred Hospital, Melbourne, Victoria, Australia.
Krishna
K
Baghwat
Department of Anaesthetics and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
Chris
C
Bain
D000368:Aged; D003329:Coronary Vasospasm / Q000150:complications* / Q000503:physiopathology*; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000503:physiopathology*; D008297:Male