title: [Severe Perioperative Coronary Artery Spasm in Thoracic Aortic Surgery; Report of Two Cases].
abstract: We report 2 cases of severe perioperative coronary artery spasm in thoracic aortic surgery. Case 1 was a 72-year-old male with a distal arch aneurysm of 74 mm while case 2 was a 74-year-old male with acute type A aortic dissection. We performed thoracic aortic repair (total arch replacement and ascending aorta replacement) under moderately hypothermic circulatory arrest (25 °C) and selective cerebral perfusion in both cases. ST elevation, abnormal left ventricular wall motion, and hypotension were noted intraoperatively. Because we were not able to wean the patients from the cardiopulmonary bypass, intraaortic balloon pump was initiated in case 1 and a coronary artery bypass graft was added in case 2. In addition to using vasodilators such as diltiazem, case 1 recovered without further intervention, but case 2 developed cardiopulmonary arrest and needed resuscitation on postoperative day 5 because of recurrence of coronary spasm. Perioperative coronary artery spasm is rare especially in aortic surgery, and may become lethal. Early recognition and special hemodynamic support is required.
authors.affiliation: Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Osada
authors.forename: Naoki
authors.initials: N
authors.lastname: Kanemitsu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kushiyama
authors.forename: Masashi
authors.initials: M
authors.lastname: Kato
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Meshii
authors.forename: Motoaki
authors.initials: M
authors.lastname: Ohnaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D003324:Coronary Artery Disease; D006801:Humans; D008297:Male; D059035:Perioperative Period; D013035:Spasm