Zohourian Hajir, Bhandari Rohit K, Atanasoski McCormack Violeta
Broward Health Medical Center, Nova Southeastern University, Fort Lauderdale, Florida, USA.
Heart Center of Excellence, Broward Health Medical Center, Fort Lauderdale, Florida, USA.
BMJ Case Rep. 2019 Jul 10;12(7):e229748. doi: 10.1136/bcr-2019-229748.
Native right coronary artery (RCA) spasm is a less frequent early complication of perioperative coronary artery bypass grafting. Late presentation at 6 days postoperation is scarce and its relationship with an anomalous coronary artery is unknown. The optimal management and prevention remains controversial. In the case presented, the patient's anomalous left coronary artery originating from the right coronary cusp underwent ligation at its proximal segment at the time of bypass grafting. This ligation was preformed to prevent competitive flow. Six days postoperation, a refractory spasm of dominant native RCA occurred. The spasm resulted in right ventricular failure. Administration of intracoronary verapamil had a longer sustained vasodilatory effect and resolution of coronary spasm when compared with intracoronary nitroglycerine injection. An intra-aortic balloon pump, inotropic agents and low-dose nitroglycerine were used to maintain adequate haemodynamic support. Right ventricular systolic function recovery was noted within 2 days postintervention.
先天性右冠状动脉（RCA）痉挛是冠状动脉旁路移植围手术期较少见的早期并发症。术后6天出现延迟表现的情况很少见，且其与冠状动脉异常的关系尚不清楚。最佳的处理和预防方法仍存在争议。在本病例中，患者起源于右冠状动脉瓣叶的异常左冠状动脉在旁路移植时在其近端进行了结扎。进行该结扎是为了防止竞争性血流。术后6天，主要的先天性RCA发生了难治性痉挛。痉挛导致右心室衰竭。与冠状动脉内注射硝酸甘油相比，冠状动脉内给予维拉帕米具有更长时间的持续血管舒张作用并能缓解冠状动脉痉挛。使用主动脉内球囊泵、正性肌力药物和低剂量硝酸甘油来维持足够的血流动力学支持。干预后2天内观察到右心室收缩功能恢复。
