Nagasawa Ayako, Okonogi Shuichi, Ohki Satoshi, Ohbayashi Tamiyuki
Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan.
Interdiscip Cardiovasc Thorac Surg. 2023 Jan 9;36(1). doi: 10.1093/icvts/ivac288.
Postoperative coronary artery spasm occurs rarely after valve replacement surgery. We report the case of a 64-year-old man with normal coronary arteries who underwent aortic valve replacement. Nineteen hours postoperatively, his blood pressure plummeted with an elevated ST-segment. Coronary angiography demonstrated a 3-vessel diffuse coronary artery spasm, and direct intracoronary infusion therapy was performed with isosorbide nitrate, nicorandil and sodium nitroprusside hydrate within 1 h of onset. Nonetheless, there was no improvement, and the patient was resistant to treatment. The patient died due to prolonged low cardiac function and pneumonia complications. Prompt intracoronary vasodilator infusion is considered effective. However, this case was refractory to multi-drug intracoronary infusion therapy and was not salvageable.
冠状动脉痉挛在瓣膜置换术后很少发生。我们报告一例64岁冠状动脉正常的男性患者，其接受了主动脉瓣置换术。术后19小时，他的血压骤降，ST段抬高。冠状动脉造影显示三支血管弥漫性冠状动脉痉挛，发病后1小时内给予硝酸异山梨酯、尼可地尔和硝普钠进行直接冠状动脉内灌注治疗。尽管如此，病情并无改善，患者对治疗抵抗。患者因长期心功能低下和肺炎并发症死亡。及时进行冠状动脉内血管扩张剂灌注被认为是有效的。然而，该病例对多种药物冠状动脉内灌注治疗无效，无法挽救。
