Intraoperative Acute Multivessel Coronary Vasospasm in Cardiac Allograft

Abstract

We present a patient who developed acute intraoperative cardiac failure requiring open cardiac message immediately after uncomplicated heart transplantation. After successful resuscitation and establishment of extracorporeal membrane oxygenation, coronary angiography showed diffuse multivessel coronary vasospasm, which responded to intracoronary and IV administration of vasodilators. Cardiac function gradually improved and the patient was discharged home after a prolonged hospital course. Cardiac allograft dysfunction associated with coronary vasospasm immediately after heart transplantation has not previously been reported.

Intractable right coronary artery spasm in the early postoperative period after heart transplantation: a case report

“…Although extremely rare, a few cases have been published describing recipient hearts that exhibited vasospastic responses early after cardiac transplantation [ 2 - 4 ]. In two of these cases, RCA spasms repeatedly occurred within 4 weeks of cardiac transplantation, but the patients were stabilized using a calcium channel blocker and discharged without recurrence.…”

“…The sufficient use of vasodilating agents, such as calcium channel blockers and nitrates, is important in patients at high risk for CAS [ 6 ]. Early initiation of MCS is another option if optimal medical treatment is not possible [ 4 ]. In this case, only low-dose intravenous nicorandil was administered because of the patient’s low blood pressure after surgery, and MCS was eventually applied after the second CAS.…”

“…Coronary artery spasm (CAS) is an extremely rare complication that can occur after cardiac transplantation [ 1 - 4 ]. In the largest single-center observational study on CAS in heart transplant recipients, 12 out of 247 patients (4.9%) experienced CAS, all within 1–3 years after heart transplantation [ 1 ].…”

Case report - coronary vasospasm in transplanted heart: a puzzling phenomenon

“…This could only be achieved through high-quality multidisciplinary care, which was life-saving for the patient. Whether CAS was also involved in primary graft failure in the immediate post-operative phase will never be known, though it has been reported elsewhere [14].…”

“…For the diagnosis, ECG changes in ST-T segments during chest symptoms, including good response to nitroderivates, is very important, but the gold standard is represented by Spasm Provocating Tests (SPT), using either Acethylcoline (Ach), either Ergonovine maleate (EM) or a combination of both (sequential SPT): the criteria of positivity is a > 90% transient stenosis of a coronary artery with signs/symptoms of myocardial ischemia [14, 15, 16].…”