Refractory diffuse coronary artery spasm post aortic valve replacement

Abstract Postoperative coronary artery spasm occurs rarely after valve replacement surgery. We report the case of a 64-year-old man with normal coronary arteries who underwent aortic valve replacement. Nineteen hours postoperatively, his blood pressure plummeted with an elevated ST-segment. Coronary...

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Bibliographic Details
Published in:Interdisciplinary cardiovascular and thoracic surgery 2023-01, Vol.36 (1)
Main Authors: Nagasawa, Ayako, Okonogi, Shuichi, Ohki, Satoshi, Ohbayashi, Tamiyuki
Format: Article
Language:English
Subjects:
Adult Cardiac
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Summary:Abstract Postoperative coronary artery spasm occurs rarely after valve replacement surgery. We report the case of a 64-year-old man with normal coronary arteries who underwent aortic valve replacement. Nineteen hours postoperatively, his blood pressure plummeted with an elevated ST-segment. Coronary angiography demonstrated a 3-vessel diffuse coronary artery spasm, and direct intracoronary infusion therapy was performed with isosorbide nitrate, nicorandil and sodium nitroprusside hydrate within 1 h of onset. Nonetheless, there was no improvement, and the patient was resistant to treatment. The patient died due to prolonged low cardiac function and pneumonia complications. Prompt intracoronary vasodilator infusion is considered effective. However, this case was refractory to multi-drug intracoronary infusion therapy and was not salvageable. Postoperative coronary artery spasm (CAS) is an infrequent life-threatening event after cardiac surgery that can occur without an underlying coronary disease.
ISSN:2753-670X
2753-670X
DOI:10.1093/icvts/ivac288