Korean J Thorac Cardiovasc Surg.  2014 Oct;47(5):468-472. 10.5090/kjtcs.2014.47.5.468.

Refractory Vascular Spasm Associated with Coronary Bypass Grafting

• Kim YS
• Yoon YH
• Kim JT
• Shinn HK
• Woo SI
• Baek WK

• KMID: 2382192
• DOI: http://doi.org/10.5090/kjtcs.2014.47.5.468

Abstract

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.

Keyword

Coronary vasospasm; Coronary artery bypass

MeSH Terms

Adult
Arteries
Cardiopulmonary Bypass
Catheterization
Causality
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease
Coronary Vasospasm
Coronary Vessels
Emergencies
Extracorporeal Membrane Oxygenation
Heart Failure
Hemodynamics
Humans
Lower Extremity
Male
Oxygenators, Membrane
Spasm*
Stents
Transplants*