Pragliola Claudio, Gaudino Mario, Farina Piero, Massetti Massimo
Department of Cardiovascular Sciences, Catholic University, Largo Gemelli 8, 00168 Roma, Italy.
Department of Cardiovascular Sciences, Catholic University, Largo Gemelli 8, 00168 Roma, Italy.
Int J Surg Case Rep. 2015;8C:185-8. doi: 10.1016/j.ijscr.2015.01.049. Epub 2015 Jan 31.
Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease
We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal.
A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment.
This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery.
术后冠状动脉痉挛是心脏手术后罕见的危及生命的事件，可在无潜在冠状动脉疾病的情况下发生。
我们报告一例有记录的67岁男性患者，其冠状动脉正常，接受了二尖瓣置换术。术后即刻，他下壁导联出现ST段抬高，经食管超声显示下壁运动减弱。冠状动脉造影显示右冠状动脉局灶性痉挛，经冠状动脉内注射硝酸盐成功治疗。术后接下来的病程平稳，左心室功能恢复正常。
瓣膜手术后发生术后梗死时，尤其是在没有相关冠状动脉疾病的情况下，应怀疑冠状动脉痉挛。在这种情况下，术后冠状动脉造影可实现诊断和治疗。
本病例报告总结了这种罕见且可能危及生命的术后早期缺血原因的发现，并强调了早期冠状动脉造影在心脏手术后疑似心肌梗死病例中的作用。
