IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Spasms of Coronary Artery Immediately After Off-Pump Bypass Grafting
Akihiro Nabuchi, MD,
Atsushi Kurata, MD,
Hiroshi Okuyama, MD,
Yasushi Muto, MD,
Yuki Endo, MD
Department of Cardiac Surgery, Yamato Seiwa Hospital, Yamato City, Kanagawa, Japan
Akihiro Nabuchi, MD Tel: +81 462783911 Fax: +81 462785787 Email: nabuchi{at}seiwa.or.jp, Department of Cardiac Surgery, Yamato Seiwa Hospital, 2-4-6 Minamirinkan Yamato City Kanagawa, Japan 242-0006.
A 70-year-old lady underwent successful off-pump coronary artery grafting of the left internal thoracic artery to the left anterior descending artery (LAD). On transfer to the intensive care unit, an electrocardiogram showed ST-segment depression in leads V5 and V6. Ultrasound examination showed very little diastolic blood flow in the arterial conduit, suggesting little flow to the LAD. Angiography showed narrowing of several sections of the LAD, despite a satisfactory appearance of the graft and anastomotic site (Figure 1A
). Spasms of the LAD were diagnosed, and diltiazem infusion (1.0 µg·min–1·kg–1) was started. The electrocardiogram normalized 7 h later. Ultrasound findings 5 days later showed improved graft flow. An angiogram 7 days postoperatively revealed normal flow in the LAD (Figure 1B). Spasms of the LAD after grafting have seldom been shown angiographically.
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Figure 1. Angiograms: (A) immediately postoperatively, showing a satisfactory left internal thoracic artery graft but distinct narrowing just proximal to the anastomotic site and a spastic appearance of the entire length of the left anterior descending artery; (B) 7 days later, these features had disappeared.
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Asian Cardiovasc Thorac Ann 2010;
18:90
© 2010 by SAGE Publications
DOI: 10.1177/0218492309355198
