Refractory coronary spasm

초록

Diffuse refractory coronary spasm associated with coronary bypass grafting is rare but devastating. We report here a case of refractory coronary spasm in a 42-year–old male patient who had been referred for the surgical treatment of recurrent left main coronary artery disease. A year earlier, he had a history of being resuscitated from sudden cardiac arrest outside hospital. Emergency PCI was done and the stent was put in the left main coronary artery at that time. Bilateral ITA grafting was planned. While on harvesting right ITA, hemodynamic derangement developed. Cardiopulmonary bypass(CPB) was instituted hurriedly and double bypass (LITA-LCx, RITA-LAD) was carried out under standard hypothermic CPB. The aortic cross clamp was released but heart beat did not return. IABP support was begun and an additional bypass with a vein graft was made to LAD but the situation was getting worse. He was rushed to the angio room and the angiography revealed diffuse coronary spasm which was unresponsive to nitrate infusion, although bypass grafts were patent. The CPB was switched to femoral to femoral ECMO and he was put desperately in the transplantation list. Surprisingly, heart beat returned on the next day and was able to be weaned off EMCO on the second postoperative day. Though he eventually recovered from heart failure, his postoperative course was significantly prolonged due to ischemic injury of the lower limb caused by ECMO circuit.