Shafei H, Bennett J G
National Heart Hospital, London, UK.
Eur J Cardiothorac Surg. 1990;4(7):398-400. doi: 10.1016/1010-7940(90)90050-a.
Coronary artery spasm has been reported as a cause of myocardial ischaemia and necrosis during and after coronary revascularisation [1-4, 9, 11, 13, 14], but not after valve replacement. We report a case in which profound myocardial ischaemia after mitral valve replacement leading to difficulty in terminating cardiopulmonary bypass was caused by coronary vasospasm. It is suggested that coronary vasospasm has to be considered among the causes of myocardial insufficiency after cardiopulmonary bypass, even in the absence of coronary artery disease, and effective treatment may be obtained by coronary vasodilating drugs.
冠状动脉痉挛已被报道为冠状动脉血运重建期间及之后心肌缺血和坏死的一个原因[1-4, 9, 11, 13, 14]，但在瓣膜置换术后未见报道。我们报告了一例二尖瓣置换术后因冠状动脉痉挛导致严重心肌缺血，进而难以终止体外循环的病例。提示即使在没有冠状动脉疾病的情况下，冠状动脉痉挛也应被视为体外循环后心肌功能不全的原因之一，使用冠状动脉扩张药物可能获得有效治疗。
