Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
Department of Operation Management, West China Hospital, Sichuan University, Chengdu, P.R. China.
Heart Surg Forum. 2021 Aug 25;24(4):E731-E733. doi: 10.1532/hsf.4005.
Few cases have been reported about coronary artery spasm after a mitral valve replacement and concomitant Cox-Maze IV procedure. We report the case of an adult male who developed right coronary artery (RCA) spasm after a mitral valve replacement with tricuspid valve repair and Cox-Maze IV procedure.
A 66-year-old male, complaining of progressive exertional shortness of breath, was diagnosed with severe mitral stenosis, moderate tricuspid regurgitation, complete right bundle branch block, and persistent atrial fibrillation (AF) in our clinic. The patient underwent elective mitral valve replacement, tricuspid valve repair, and Cox-Maze IV procedure. Four hours after surgery, a 12-lead electrocardiogram (ECG) showed progressive elevation of ST-segment in the avF and III leads and Troponin-T was over 7000 pg/mL. After one hour, Troponin-T increased to over 10000 pg/mL, and ECG still showed persisted ST-segment elevation in inferior leads. Emergent angiography was performed, and intra-coronary administration of nitroglycerin completely relieved the spasm.
Potential risks of coronary injury after valvular surgery and Cox-Maze IV procedure need further aggressive investigation and postoperative ischemia should prompt an emergent coronary angiography to identify the cause and apply immediate therapy.
二尖瓣置换术和同期 Cox-Maze IV 手术后继发冠状动脉痉挛的病例较少。我们报告了一例成年男性在二尖瓣置换术、三尖瓣修复术和 Cox-Maze IV 手术后发生右冠状动脉（RCA）痉挛的病例。
一名 66 岁男性，因进行性劳力性呼吸困难在我院就诊，诊断为重度二尖瓣狭窄、中度三尖瓣反流、完全性右束支传导阻滞和持续性心房颤动（AF）。患者接受了择期二尖瓣置换术、三尖瓣修复术和 Cox-Maze IV 手术。术后 4 小时，12 导联心电图（ECG）显示 avF 和 III 导联 ST 段逐渐抬高，肌钙蛋白 T 超过 7000 pg/mL。1 小时后，肌钙蛋白 T 增加到超过 10000 pg/mL，ECG 仍显示下壁导联持续 ST 段抬高。紧急进行冠状动脉造影，冠状动脉内给予硝酸甘油完全缓解痉挛。
瓣膜手术后和 Cox-Maze IV 手术后冠状动脉损伤的潜在风险需要进一步积极调查，术后缺血应促使进行紧急冠状动脉造影以确定病因并立即进行治疗。
