J Korean Med Sci.  2010 Apr;25(4):641-643. 10.3346/jkms.2010.25.4.641.

Native Coronary Artery and Grafted Artery Spasm Just after Coronary Artery Bypass Grafting: A Case Report

• Baek JH
• Han SS
• Lee DH

• KMID: 1792940
• DOI: http://doi.org/10.3346/jkms.2010.25.4.641

Abstract

Native coronary artery spasm after coronary artery bypass grafting (CABG) is scarce. It frequently causes disastrous circulatory collapse. We report a 72-yr-old male, who experienced native coronary artery spasm and grafted artery spasm following CABG, which was successfully treated with coronary angiography and intracoronary injection of nitroglycerine.

Keyword

Coronary Artery Bypass; Coronary Vasospasm

MeSH Terms

Aged
Coronary Angiography
Coronary Artery Bypass/*adverse effects
Coronary Vasospasm/drug therapy/*etiology
*Coronary Vessels/drug effects/physiopathology/surgery
Humans
Male
Nitroglycerin/therapeutic use
Treatment Outcome
Vasodilator Agents/therapeutic use
Vasodilator Agents
Nitroglycerin

Figure

• 

  Fig. 1 Preoperative & postoperative coronary angiography. I. Preoperative coronary angiogram shows significant stenosis at distal left main coronary artery (A, arrowhead). Also shows normal right coronary artery (B). II. Postoperative coronary angiogram (about 2 hr after operation) shows severe spastic narrowing at grafted native coronary arteries (A, left anterior descending and left circumflex arteries), untouched native coronary artery (B, right coronary artery) and composite Y-graft (C, internal thoracic artery-radial artery). III. After intracoronary nitroglycerine injection, coronary angiography shows relief of spastic narrowing at grafted, non-grafted native coronary arteries (A, left anterior descending artery and B, right coronary artery), and composite Y-graft (C).

Reference

1. Lemmer JH Jr, Kirsh MM. Coronary artery spasm following coronary artery surgery. Ann Thorac Surg. 1988. 46:108–115.

2. Kim YH, Kim H, Chung YS, Kang JH, Chung WS, Shinn SH. Low cardiac output syndrome caused by a coronary artery spasm following CABG. Korean J Thorac Cardiovasc Surg. 2007. 40:633–636.

3. Buxton AE, Goldberg S, Harken A, Hirshfield J Jr, Kastor JA. Coronary-artery spasm immediately after myocardial revascularization: recognition and management. N Engl J Med. 1981. 304:1249–1253.

4. Lockerman ZS, Rose DM, Cunningham JN Jr, Lichstein E. Postoperative ST-segment elevation in coronary artery bypass surgery. Chest. 1986. 89:647–651.

5. Schena S, Wildes T, Beardslee MA, Lasala JM, Damiano RJ Jr, Lawton JS. Successful management of unremitting spasm of the nongrafted right coronary artery after off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2007. 133:1649–1650.

6. Paterson HS, Jones MW, Baird DK, Hughes CF. Lethal postoperative coronary artery spasm. Ann Thorac Surg. 1998. 65:1571–1573.

7. Tarhan IA, Kehlibar T, Arslan Y, Yilmaz M, Dumantepe M, Berkoz K, Pancaroglu C, Ozler A. Effects of normothermic organ bath and verapamil-nitroglycerin solution alone or in combination on the blood flow of radial artery. Eur J Cardiothorac Surg. 2007. 32:617–622.