Kanno M, Kurihara H, Satoh H, Hamawaki M, Honda M
Department of Cardiovascular Surgery, Honda Memorial Hospital, Koriyama, Japan.
Kyobu Geka. 1994 Apr;47(4):315-8.
A 50-year-old female with a malfunctioning bioprosthetic mitral valve which was implanted 7 years earlier underwent reoperation. She had no history of angina pectoris. Calcium channel blockers and nitrates had not been taken by the patient. Coronary arteriograms were normal. About 2 hours after the reoperation, EKG monitor showed abrupt ST segment elevation which was immediately followed by ventricular tachycardias and fibrillations. This life threatening circulatory collapse recurred until a drip infusion of diltiazem was started. Maximum CPK-MB was 145 IU/l. Postoperative coronary arteriography, which was performed after 12 hours of withhold of diltiazem, showed a spasm in the proximal segment of the right coronary artery. Coronary artery spasm should be considered among the causes of abrupt and unexpected circulatory collapse after open heart surgery even in the absence of coronary artery disease.
一名50岁女性，7年前植入的生物人工二尖瓣出现功能故障，接受了再次手术。她没有心绞痛病史。患者未服用过钙通道阻滞剂和硝酸盐类药物。冠状动脉造影正常。再次手术后约2小时，心电图监测显示ST段突然抬高，随后立即出现室性心动过速和心室颤动。这种危及生命的循环衰竭反复出现，直到开始静脉滴注地尔硫䓬。肌酸磷酸激酶同工酶（CPK-MB）最高值为145 IU/l。在停用12小时地尔硫䓬后进行的术后冠状动脉造影显示右冠状动脉近端节段痉挛。即使没有冠状动脉疾病，心脏直视手术后突然和意外的循环衰竭原因中也应考虑冠状动脉痉挛。
