Minato N, Itoh T, Natsuaki M, Furukawa K, Rikitake K, Yamamoto H
Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Japan.
J Cardiovasc Surg (Torino). 1995 Apr;36(2):153-7.
We experienced a rare case of Marfan's syndrome with annulo-aortic ectasia, aortic regurgitation and Prinzmetal's variant angina. In a modified Bentall's operation (button technique), perioperative severe coronary artery spasm occurred in spite of the preventive use of nitroglycerin infusion, which resulted in profound ventricular fibrillation and subsequent chordal rupture of the mitral valve with Sellers IV regurgitation. Use of nicardipine contained in cardioplegia, continuous infusion of nicardipine and nitroglycerin after aortic declamping completely prevented coronary spasm throughout the course of a second surgery for mitral valve replacement. It is worthy to report this case because of rarities such as Marfan's syndrome accompanied by Prinzmetal's variant angina, perioperative coronary artery spasm in modified Bentall's operation, and perioperative chordal rupture of the mitral valve and progression of mitral valve regurgitation. We also stress the efficacy of a new calcium antagonist, nicardipine, to prevent coronary artery spasm during open heart surgery.
我们遇到了一例罕见的马凡氏综合征患者，伴有主动脉根部扩张、主动脉瓣反流和变异型心绞痛（普萘洛尔变异型心绞痛）。在改良Bentall手术（纽扣技术）中，尽管预防性输注硝酸甘油，但围手术期仍发生了严重的冠状动脉痉挛，导致严重室颤，随后二尖瓣腱索断裂并出现 Sellers IV 级反流。在心脏停搏液中使用尼卡地平，并在主动脉钳夹松开后持续输注尼卡地平与硝酸甘油，在二尖瓣置换的第二次手术过程中完全预防了冠状动脉痉挛。由于存在马凡氏综合征合并变异型心绞痛、改良Bentall手术中的围手术期冠状动脉痉挛、围手术期二尖瓣腱索断裂以及二尖瓣反流进展等罕见情况，故值得报告此病例。我们还强调了新型钙拮抗剂尼卡地平在心脏直视手术中预防冠状动脉痉挛的疗效。
