Stoica Alexandra Iulia, Harpa Marius, Banceu Cosmin Marian, Kovacs Judith, Suciu Horatiu
George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania.
Institute for Cardiovascular Diseases and Heart Transplantation, Targu Mures, Romania.
J Crit Care Med (Targu Mures). 2022 May 12;8(2):131-135. doi: 10.2478/jccm-2022-0005. eCollection 2022 Apr.
Postoperative coronary vasospasm is a well-known cause of angina that may lead to myocardial infarction if not treated promptly. We report a case of a 70-year-old female with severe mitral regurgitation submitted to mitral valve replacement, and a history of diabetes mellitus type II, stroke, idiopathic thrombocytopenic purpura on steroid therapy, and previous percutaneous coronary intervention (PCI) for severe obstruction of the circumflex coronary artery, 4 months prior to surgery. Immediately after intensive care unit admission, the patient developed pulseless electrical activity which required extracorporeal membrane oxygenation for hemodynamic support. The coronary angiography showed diffuse occlusive coronary artery vasospasm, ameliorated after intra-coronary administration of nitroglycerin. The following postoperative evolution was marked by cardiogenic shock and multiple organ dysfunction syndrome. Subsequent echocardiographic findings showed an increase in left ventricular function with an EF of 40%, and extracorporeal membrane oxygenation (ECMO) support was weaned after seven days. However, after a few hours, the patient progressively deteriorated, with cardiac arrest and no response to resuscitation maneuvers. Hemodynamic instability following the surgical procedure in a patient with previous PCI associated with an autoimmune disease and diabetes mellitus should raise the suspicion of a coronary artery vasospasm.
术后冠状动脉痉挛是心绞痛的一个众所周知的原因，如果不及时治疗可能导致心肌梗死。我们报告一例70岁女性，患有严重二尖瓣反流，接受了二尖瓣置换术，有II型糖尿病、中风、正在接受类固醇治疗的特发性血小板减少性紫癜病史，以及术前4个月因回旋支冠状动脉严重阻塞接受过经皮冠状动脉介入治疗（PCI）。在重症监护病房入院后不久，患者出现无脉电活动，需要体外膜肺氧合进行血流动力学支持。冠状动脉造影显示弥漫性闭塞性冠状动脉痉挛，冠状动脉内给予硝酸甘油后有所改善。术后接下来的病程以心源性休克和多器官功能障碍综合征为特征。随后的超声心动图检查结果显示左心室功能有所改善，射血分数为40%，体外膜肺氧合（ECMO）支持在7天后撤离。然而，几个小时后，患者病情逐渐恶化，出现心脏骤停，对复苏措施无反应。既往有PCI史、合并自身免疫性疾病和糖尿病的患者术后出现血流动力学不稳定应怀疑冠状动脉痉挛。
