Kowalówka Adam R, Malinowski Marcin, Onyszczuk Magdalena, Deja Marek
Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
Kardiochir Torakochirurgia Pol. 2016 Dec;13(4):361-365. doi: 10.5114/kitp.2016.64883. Epub 2016 Dec 30.
We report on a 69-year-old woman who demonstrated native coronary artery and grafted vessel spasm following on-pump coronary artery bypass grafting (CABG). Despite intraaortic balloon pump (IABP) insertion, electrocardiogram (ECG) abnormalities did not disappear. Emergency coronary angiography (CAG) was performed. The patient was successfully treated with systemic and intracoronary injection of vasodilator agents. ECG changes disappeared, with normalized and stable hemodynamic function. Intraaortic balloon pump was maintained for 48 h. The patient was discharged in good clinical condition. Coronary artery spasm (CAS) may result in life-threatening arrhythmias, circulatory collapse or death. The etiology of CAS is multifactorial and includes heart manipulation, exogenous vasoconstrictors, stress-related catecholamine release, hypoxia and oxidative stress. Postoperative CAS is most commonly manifested by ST-segment elevation and circulatory collapse without specific causes. The gold standard for revealing CAS is CAG. Infusion of vasodilators combined with IABP is adequate in most instances, but extracorporeal membrane oxygenation has been necessary for more extensive or resistant coronary spasm.
我们报告了一名69岁女性，她在体外循环冠状动脉旁路移植术（CABG）后出现了自身冠状动脉和移植血管痉挛。尽管插入了主动脉内球囊泵（IABP），心电图（ECG）异常仍未消失。进行了急诊冠状动脉造影（CAG）。通过全身和冠状动脉内注射血管扩张剂成功治疗了该患者。ECG变化消失，血流动力学功能恢复正常且稳定。主动脉内球囊泵维持了48小时。患者出院时临床状况良好。冠状动脉痉挛（CAS）可能导致危及生命的心律失常、循环衰竭或死亡。CAS的病因是多因素的，包括心脏操作、外源性血管收缩剂、应激相关的儿茶酚胺释放、缺氧和氧化应激。术后CAS最常见的表现是ST段抬高和无特定原因的循环衰竭。揭示CAS的金标准是CAG。在大多数情况下，血管扩张剂输注联合IABP就足够了，但对于更广泛或难治性冠状动脉痉挛，体外膜肺氧合是必要的。
