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Case Reports
. 2022 Apr 12;22(1):166.
doi: 10.1186/s12872-022-02609-6.

Perioperative coronary artery spasm after off-pump coronary artery bypass grafting in the non-manipulated coronary artery

Yunpeng Bai #  1   2 , Yiming Bai #  2   3 , Nan Jiang  1   2 , Qingliang Chen  4   5 , Zhigang Guo  6   7
Affiliations
Case Reports

Perioperative coronary artery spasm after off-pump coronary artery bypass grafting in the non-manipulated coronary artery

Yunpeng Bai et al. BMC Cardiovasc Disord. .

Abstract

Background: Perioperative coronary artery spasm (CAS) following coronary artery bypass grafting (CABG) is a severe or lethal condition that is rarely reported. In addition, rare cases with CAS following CABG in the non-manipulated coronary artery are angiographically documented in the perioperative period. We aimed to report our experiences on the diagnosis and treatment of a case with CAS following off-pump CABG in the non-manipulated coronary artery.

Methods: A 57-year old male with coronary heart disease and unstable angina willing to undergo CABG was admitted to our department. CABG was recommended as he showed 90% stenosis in distal left anterior descending artery, 90% stenosis in intermediate branch, 90% stenosis in left circumflex coronary artery, as well as 50% stenosis in proximal right coronary artery (RCA).

Results: After CABG, the patient showed Adams-Stokes syndrome and ST-segment elevation. Then CPR was conducted and coronary angiography indicated perioperative CAS in the non-manipulated posterior descending artery. For the treatment, the patient received nitroglycerin injection into the coronary artery by catheter and pumping of diltiazem. Finally, the patient was discharged on day 7 after surgery. A comprehensive literature search was conducted to summarize the studies focused on the diagnosis and treatment of such condition, which indicated that all of the CAS cases occurred in the manipulated vessels, except one study showing CAS in the untouched native coronary artery which was similar with our case.

Conclusions: Perioperative CAS in the non-manipulated coronary artery following CABG is a severe or lethal condition that is rarely reported, which deserves close attention by the clinicians in clinical practice.

Keywords: Angiography; Calcium channel blocker; Coronary artery bypass grafting; Coronary artery spasm.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
ECG findings of the patient. A Preoperative ECG. B ECG performed after removal of respirator at postoperative 17 h. C ECG performed at postoperative 23 h when the patient showed Adams–Stokes syndrome
Fig. 2
Fig. 2
Preoperative and postoperative coronary angiography. A Preoperative angiography indicated 50% stenosis in right main coronary artery. B Angiographic findings of right coronary artery after onset of Adams-Stokes syndrome. C After administration of nitroglycerin into the spasm site, the posterior descending branch was visualized. White arrow indicated the spasm in the orifice of the posterior descending branch in the non-manipulated vessel
See this image and copyright information in PMC

References

    1. Matta A, Bouisset F, Lhermusier T, Campelo-Parada F, Elbaz M, Carrié D, et al. Coronary artery spasm: new insights. J Interv Cardiol. 2020;2020:5894586. doi: 10.1155/2020/5894586. - DOI - PMC - PubMed
    1. Yasue H, Mizuno Y, Harada E. Coronary artery spasm—clinical features, pathogenesis and treatment. Proc Jpn Acad Ser B Phys Biol Sci. 2019;95(2):53–66. doi: 10.2183/pjab.95.005. - DOI - PMC - PubMed
    1. Alexander JH, Smith PK. Coronary-artery bypass grafting. N Engl J Med. 2016;374(20):1954–1964. doi: 10.1056/NEJMra1406944. - DOI - PubMed
    1. Carneiro Neto JD, Lima Neto JA, Simões RM, Stolf NA. Coronary-artery spasm after coronary artery bypass graft surgery without extracorporeal circulation: diagnostic and management. Rev Bras Cir Cardiovasc. 2010;25(3):410–414. doi: 10.1590/S0102-76382010000300020. - DOI - PubMed
    1. He GW, Taggart DP. Spasm in arterial grafts in coronary artery bypass grafting surgery. Ann Thorac Surg. 2016;101(3):1222–1229. doi: 10.1016/j.athoracsur.2015.09.071. - DOI - PubMed

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