Sawaki Sadanari, Matsuura Akio, Ito Hideki, Saito Shunei, Takemura Haruki, Miyahara Ken, Ashida Shinichi, Mori Shunsuke, Takanohashi Akira, Yagami Kei, Usui Masato, Hirate Yuuichi
Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Kyobu Geka. 2010 Feb;63(2):102-5.
We report a case of 72-year-old man with severe manifestations of coronary artery spasm immediately after aortic valve replacement (AVR), which was associated with hemodynamic and arrhythmic instability. The AVR was performed under mild hypothermic cardiopulmonary bypass (34 degrees C), and retrograde blood cardioplegia was intermittently delivered at the same temperature. Immediately after the operation, the patient suddenly developed severe bradycardia and hypotension, and repeated ventricular fibrillation. Percutaneous cardiopulmonary support system (PCPS) and intra-aortic balloon pumping (IABP) were required for this circulatory collapse. Echocardiography revealed left ventricular segmental dysfunction, and coronary artery bypass grafting (CABG) to the right coronary artery and the left ascending artery was performed [during CABG, coronary spasm was strongly suspected by repetitive ST elevation and depression on electrocardiogram (ECG) monitor]. Eventually, the spasm subsided with the intravenous infusion of nitrates, nicorandil, and diltiazem. The remaining postoperative course was uneventful and the patient was discharged on the 24th postoperative day in good clinical condition.
我们报告一例72岁男性患者，在主动脉瓣置换术（AVR）后立即出现严重的冠状动脉痉挛表现，伴有血流动力学和心律失常不稳定。AVR在轻度低温体外循环（34摄氏度）下进行，在相同温度下间歇性给予逆行血液停搏液。术后立即，患者突然出现严重心动过缓和低血压，并反复发生心室颤动。这种循环衰竭需要使用经皮心肺支持系统（PCPS）和主动脉内球囊反搏（IABP）。超声心动图显示左心室节段性功能障碍，并对右冠状动脉和左升动脉进行了冠状动脉旁路移植术（CABG）[在CABG期间，心电图（ECG）监测反复出现ST段抬高和压低，强烈怀疑冠状动脉痉挛]。最终，静脉输注硝酸盐、尼可地尔和地尔硫卓后痉挛缓解。术后其余过程顺利，患者术后第24天临床状况良好出院。
