Coronary Artery Spasm Following Off-Pump Coronary Artery Bypass Surgery

Abstract

SummaryCoronary artery spasm after coronary artery bypass surgery may result in life-threatening arrhythmias, circulatory collapse, or death. We report two cases of coronary artery spasm after coronary artery bypass surgery, one of which developed ventricular fibrillation requiring extracorporeal membrane oxygenation support. Both patients were discharged in good condition and are currently followed as outpatients. Unexpected sudden hemodynamic compromise could be due to coronary vasospasm, and this should be considered as one of the possible differential diagnoses. We were able to prevent the lethal consequences seen with coronary artery spasm by early diagnosis and management. (Int Heart J 2014; 55: 451-454)

Coronary Artery Spasm is a Nightmare: A Rare Case of Multi Vessel Coronary Artery Spasm

“…He died from various complications. In the cases of cardiogenic shock or cardiac arrest secondly to severe coronary artery spasm, IABP is sufficient to support the patient's hemodynamics [5], in the other cases of severe cardiogenic shock or cardiac arrest secondly to severe coronary artery spasm, IABP is not sufficient to support the patient's hemodynamics and more advanced mechanical circulatory support devices such as veno-arterial ECMO should be performed [6]. After initiation of ECMO, catecholamine infusions which may aggravate coronary artery spasm by the alpha-adrenergic effect can be discontinued, since ECMO can provide full circulatory support.…”

Coronary artery spasm following on-pump coronary artery bypass grafting with 20 months follow-up

“…The CAS after CABG is a rare (0.8–1.3%) but life-threatening complication with high morbidity and mortality [1]. It can occur during surgery or in the immediate postoperative period.…”

“…It can occur during surgery or in the immediate postoperative period. It may involve manipulated or non-manipulated vessels, an implanted graft or native coronary arteries [2], but the RCA is most commonly involved [1]. The etiology of CAS after CABG is still undetermined, but several factors could induce vasospasm: vascular damage, oxidative stress, high levels of administered or endogenous vasoconstrictors, electrolyte abnormalities (hypomagnesaemia, hyperkalaemia), hypothermia, hypocapnia, preoperative use of β-blocking agents, calcium channel blockers (CCB) and high dosage of nitroglycerine [3].…”

“…Preoperative recognition of high-risk patients, avoiding manipulation of the heart to minimize surgical trauma, minimizing the use of the carbon dioxide blower and avoiding hypothermia have all been proposed for the prevention of CAS. Postoperatively infusion of nitroglycerine, calcium antagonists and supplemental magnesium may decrease the risk of CAS [1]. …”

Late-Onset Postoperative Junctional Ectopic Tachycardia in Nonsurgical Procedures

“…Postoperative JET may produce unfavorable haemodynamics that prolong the stays in the cardiac intensive care unit and hospital, prolong the time on a ventilator, and on rare occasions require the use of extracorporeal membrane oxygenation (ECMO) 2) as rescue therapy to respond to low cardiac output or adverse effects following the administration of antiarrhythmic medications. 3) The exact mechanism of JET remains unclear.…”