Coronary artery spasm and ventricular fibrillation after off-pump coronary surgery

doi:10.1016/S0003-4975(01)02860-0

The Annals of Thoracic Surgery

Volume 73, Issue 1, January 2002, Pages 297-300

https://doi.org/10.1016/S0003-4975(01)02860-0 Get rights and content

Abstract

Native coronary artery or bypass graft spasm is a rare cause of acute myocardial infarction after coronary artery bypass grafting. This report presents angiographic documentation of native coronary artery spasm following successful multivessel off-pump coronary revascularization, which caused myocardial ischemia leading to inferior wall myocardial infarction and ventricular fibrillatory arrest.

Section snippets

Comment

The few previously reported cases of perioperative coronary artery spasms with immediate angiographic documentation have demonstrated either diffuse nonocclusive spasm in all native coronary arteries or spasm localized to a nongrafted right coronary artery [2]. The causes of coronary artery spasm after coronary artery bypass grafting are not fully understood. Several factors thought to provoke spasm may interact in the postoperative period including high endogenous catecholamine levels,

References (5)

L.A. Pires et al.
Arrhythmias and conduction disturbances after coronary artery bypass graft surgeryepidemiology, management and prognosis
Am Heart J
(1995)
R.H. Zeff et al.
Coronary artery spasm following coronary artery revascularization
Ann Thorac Surg
(1982)

There are more references available in the full text version of this article.

Cited by (19)

Levels of vitamin C In the blood plasma patients treated with coronary artery bypass grafting increases significantly after surgery
2017, Biomedicine and Pharmacotherapy
Citation Excerpt :
CABG is an established treatment of myocardial ischaemia symptoms, which significantly improves survival of patients. Coronary artery spasm [6,7] and atrial fibrillation [8–10] are a known complication of CABG and can be associated with circulatory collapse and death. Supplementation of vitamin C reduces the incidence of post CABG atrial fibrillation, and decreases the time needed for rhythm restoration and length of hospital stay [11].
One strong risk factor of coronary artery disease (CAD), which affects the levels of vitamin C in the blood is cigarette smoking. The supplementary effects of coronary artery bypass grafting (CABG) is smoking cessation by patients. Therefore, the aim of this study was to examine the level of vitamin C in the blood plasma one day before and one month after CABG. Human blood were collected from 20 patients (men); 1 day before and 1 month after CABG. All patients were smoker and after CABG they declared their not smoking. The concentration of vitamin C in the blood plasma was assayed by FIA method with spectrophotometric detection. The mean value of the vitamin C concentration 1 day before CABG was 12.36 ± 2.84 μmol/L (mean ± SD), 1 month after CABG 40.07 ± 10.95 μmol/L (mean ± SD). The average increase in the concentration of vitamin C was 3.27 ± 0.73 times (mean ± SD) and showed significant positive correlations (Pearson r = 0.657, p = 0.002). It should be consider incorporating the recommendations of preoperative smoking cessation for at least one month prior to CABG and/or additional supplementation. In addition it would be relevant to monitor the level of vitamin C in the patients’ blood in the preoperative period.
Refractory spasm of coronary arteries and grafted conduits after isolated coronary artery bypass surgery
2012, Annals of Thoracic Surgery
Citation Excerpt :
Perioperative spasm after CABG procedure was first described by Pichard and colleagues [17]. After that description, a few other publications have reported about the occurrence of RVS [1–15]. The RVS after CABG remains mostly unexplained, and once developed represents a significant determinant of morbidity and mortality during the perioperative phase [1–15].
Refractory vascular spasm (RVS) concomitantly involving the entire coronary artery system and grafted conduits after coronary artery bypass grafting (CABG) surgery is a rare, but dreadful event. No consensus exists in terms of appropriate management.
Between 1986 and 2009, 5,762 patients underwent isolated CABG at our institution, and 7 patients experienced RVS involving the coronary arteries and implanted conduits. Mean age was 65.6 years and 3 were female. All patients received from 3 to 5 distal anastomoses, including use of the left internal mammary artery. During the same time period, 18 patients experienced perioperative vasospasm of a single coronary artery or of a grafted conduit.
All diffuse RVS events occurred between 3 and 8 hours after surgery. All patients had diffuse ischemic-like electrocardiographic changes, and 5 patients rapidly developed cardiogenic shock in the intensive care unit. Angiography was quickly performed in all patients and showed diffuse RVS involving either the native coronary arteries or the anastomosed arterial and venous conduits. The first 5 patients of this series died in the catheterization lab due to rapidly evolving refractory cardiogenic shock and unresponsive cardiac arrest, despite intraaortic counterpulsation and aggressive pharmacologic interventions (selective vasodilators and systemic inotropes). In the last 2 patients, extracorporeal membrane oxygenation was quickly instituted (1 in the catheterization lab, 1 in the operating room) and RVS could be successfully managed with complete resolution of ongoing vasospasm. In the single vascular spasm, there was only 1 death for refractory cardiac arrest, whereas all the other patients were successfully treated with direct infusion of vasodilators.
Diffuse RVS after CABG is a rare but lethal condition. Our experience, although limited, indicates that in such cases an aggressive treatment, that is, prompt extracorporeal membrane oxygenation institution and controlled cardiocirculatory assistance, represents the preferred solution to face such a dramatic event and may save patient lives.
Epicardial Ultrasonography: A Potential Method for Intraoperative Quality Assessment of Coronary Bypass Anastomoses?
2007, Annals of Thoracic Surgery
Intraoperative quality assessment in coronary artery bypass surgery confirms graft patency and enables revision of failing grafts. The aim of this study was to evaluate graft quality intraoperatively by epicardial ultrasonography and to compare this technique with transit time flow measurements and intraoperative angiography, and to evaluate the ability of these methods to predict long-term patency as described by follow-up angiography.
Thirty-nine patients with mean age of 66 years (SD 9.5) who underwent off-pump coronary artery bypass surgery with internal mammary artery graft to the left anterior descending coronary artery were included. Epicardial ultrasonography and transit time flow measurement were performed after completion of the anastomoses, and coronary angiography after closure of the chest. Follow-up angiography was carried out after 156 days (SD 50).
Diameter measurements obtained by epicardial ultrasonography correlated poorly with the same diameter measurements obtained by angiography. Epicardial ultrasonography revealed 5 abnormal grafts (13%), transit time flow measurements none, and intraoperative angiography 9 (23%). At follow-up angiography, 4 grafts (11%) were pathologic. Epicardial ultrasonography and transit time flow measurements indicated no need for graft revision; intraoperative angiography suggested need for revision in 3 cases.
Epicardial ultrasonography could be a useful method for intraoperative assessment of graft anastomosis quality, but needs to demonstrate its ability to predict grafts in need of revision. Angiography must be considered the gold standard in intraoperative imaging.
Persistent severe vasospasm in off-pump coronary artery bypass surgery: The value of intraluminal stenting
2006, Journal of Thoracic and Cardiovascular Surgery
Diffuse coronary artery spasm treated by extracorporeal membrane oxygenation
2009, European Journal of Cardio-thoracic Surgery
Potassium induced contraction of the internal thoracic artery in vitro is time related: the potential consequences in the analysis of the mechanism of the spasm after coronary artery bypass grafting and in the analysis of the results of in vitro studies
2016, Heart and Vessels

View all citing articles on Scopus

View full text

Case reportCoronary artery spasm and ventricular fibrillation after off-pump coronary surgery

Abstract

Section snippets

Comment

Am Heart J

Ann Thorac Surg

Case report
Coronary artery spasm and ventricular fibrillation after off-pump coronary surgery