Coronary artery spasm during coronary artery bypass surgery: its diagnosis, treatment and prevention

Between 1982 and 1983, we experienced four cases of hemodynamic collapse accompanied by an ST-segment depression in the ECG lead II, shortly after the cessation of cardiopulmonary bypass. The bypass graft flows monitored in these patients during the hemodynamic collapse episodes were remarkably low....

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Bibliographic Details
Published in:Japanese journal of surgery 1988-11, Vol.18 (6), p.626-635
Main Authors: FUSE, K, MAKUUCHI, H, KONISHI, T, NAKANISHI, S, NISHIYAMA, S, NISHIMURA, S, HOSODA, Y, YAMAGUCHI, H
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiology. Vascular system
Coronary Artery Bypass - adverse effects
Coronary heart disease
Coronary Vasospasm - drug therapy
Coronary Vasospasm - etiology
Coronary Vasospasm - prevention & control
Diltiazem - therapeutic use
Electrocardiography
Heart
Humans
Intraoperative Complications
Male
Medical sciences
Middle Aged
Nitroglycerin - therapeutic use
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Summary:Between 1982 and 1983, we experienced four cases of hemodynamic collapse accompanied by an ST-segment depression in the ECG lead II, shortly after the cessation of cardiopulmonary bypass. The bypass graft flows monitored in these patients during the hemodynamic collapse episodes were remarkably low. In three cases, nitroglycerin (0.5-1 mg) was injected directly into the vein graft, which increased the graft flow suddenly, returned the ST-segment to the baseline, and improved the circulatory condition. Since 1984, however, diltiazem has been used in the cardioplegic solution and postoperative drip infusion. Due to the introduction of this drug, coronary artery spasm has not been seen in any of our patients since. These findings show that the monitoring of ST-segment changes and bypass graft flows are useful in the early diagnosis of coronary artery spasm after myocardial revascularization. Direct infusion of nitroglycerin into the vein graft is effective for the treatment of spasm, while diltiazem is useful in the prevention of coronary artery spasm incidental to myocardial revascularization.
ISSN:0047-1909
1436-2813
DOI:10.1007/BF02471522