Patients With Left Main Coronary Artery Vasospasm Inadvertently Undergoing Coronary Artery Bypass Grafting Surgery

Mohammed, Asim; Yang, Andrew; Shao, Kimberly; DiSabatino, Angela; Blackwell, Ray A.; Banbury, Michael K.; Weintraub, William S.; Doorey, Andrew J.

doi:10.1016/j.jacc.2012.10.048

Cited by 15 publications

(13 citation statements)

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“…Indeed, the 2011 ACC/AHA/SCAI PCI guidelines neglect to mention the use of nitroglycerin prior to PCI to rule out CAS as a cause of significant stenosis, and only discuss intracoronary vasodilators in the setting of the no‐reflow phenomenon . The magnitude of the importance of considering CAS during diagnostic cardiac catheterization was illustrated by Doorey and coworkers, who demonstrated that of 385 patients who underwent coronary artery bypass grafting for left main coronary artery stenoses, 4.1% had no evidence of left main disease on repeat coronary angiography, suggesting that catheter‐induced vasospasm was responsible for the initial left main lesions .…”

Section: Discussionmentioning

confidence: 99%

Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines

Vishnevsky

Julien

Fischman

et al. 2017

Cathet Cardio Intervent

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Coronary artery spasm is an under-recognized cause of chest pain in patients with significant angiographic lesions. Coronary spasm should be suspected especially in younger patients (less than 60 years old) with apparent single vessel disease. IC NTG should be routinely administered during diagnostic angiography and before PCI to avert unnecessary coronary interventions. © 2017 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines

Vishnevsky

Julien

Fischman

et al. 2017

Cathet Cardio Intervent

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“…It was reported that about one-third of the left internal mammary grafts were occluded for patient who probably had left main spasm before the surgery but had no obstructive lesions on repeat angiography. 12 Even in patients with patent grafts, spasm of another artery or segment will cause symptom recurrence.…”

Section: Revascularizationmentioning

confidence: 99%

Left Main Coronary Spasm: an Extremely Rare Entity with Possible Life-Threatening Complications

Emam

Sricharoen

2015

Int J Angiol

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).Coronary artery spasm (CAS) is a known cause of acute coronary syndrome (ACS). However, left main CAS is an extremely rare entity and can present in different ways depending on the duration and severity of the spasm. We present a patient with left main and right coronary spasm resolved with intracoronary nitroglycerine; the patient responded well to outpatient management with calcium channel blockers (CCB), nitrates, and arginine. Case PresentationA 44-year-old female patient with no significant cardiac history presented to the emergency department with typical chest pain. Her vital signs were stable. Initial electrocardiogram (ECG) was within normal limits but a repeat ECG after symptom recurrence showed ST elevation in aVR and ST depression in leads I, II, aVL, and V 3 -V 6 (►Fig. 1). She was given aspirin and intravenous (IV) heparin and transferred to our facility for further care. At the time of arrival, her symptoms had resolved as well as her ECG changes. Her troponin I was borderline and CKMB (creatinine kinase-MB) remained within normal limits. Given her typical chest pain and ECG changes, she underwent coronary angiography that showed mid left main coronary spasm (►Fig. 2) that improved after intracoronary nitroglycerine injection (►Fig. 3). To confirm the absence of left main atherosclerosis, intravascular ultrasound (IVUS) of the left main artery was performed and showed minimal plaque burden (►Fig. 4). There was also ostial right CAS that resolved after intracoronary nitroglycerine. The patient was started on oral nitrates but had symptom recurrence. Amlodipine and arginine were added. No further symptoms reported. Keywords► coronary intervention ► left main coronary artery spasm ► acute coronary syndrome ► ischemia ► cardiac catheterization ► intravascular ultrasound AbstractCoronary artery spasm is a known cause of acute coronary syndrome. However, left main coronary spasm is an extremely rare entity and can present in different ways depending on the duration and severity of the spasm. We present a 44-year-old female patient who presented with transient ST elevation in the lead aVR and ST depression in the lateral and inferior leads. Coronary angiography showed mid left main and ostial right coronary artery spasm that significantly improved after intracoronary nitroglycerine administration. Intravascular ultrasound showed no significant left main coronary atherosclerosis. She was treated chronically with calcium channel blockers (CCB), nitrates, and arginine with significant improvement. In conclusion, left main coronary spasm is an extremely rare entity with wide spectrum of clinical manifestations. Definite etiology is still questionable, and special precaution is needed during coronary angiography in order not to be confused with significant fixed lesions. Intravascular ultrasound can be valuable in excluding underlying atherosclerosis. Medical management with nitrates acutely then CCB is the mainstay of chronic management with PCI preserved to refractory cases.

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“…To date, it has also been reported that coronary vasospasm mainly occurs after coronary artery bypass grafting surgery [9,10]. But there are almost no cases of vasospasm after repair operation of atrial septal defect (ASD).…”

Section: Introductionmentioning

confidence: 99%

Coronary artery vasospasm after atrial septal defect surgery

Yoon

Lee

Kim

et al. 2014

Yeungnam Univ J Med

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Coronary vasospasm is one of the fatal complications that may occur in patients undergoing open heart surgery. To date, however, there are not many cases in this series and no definite pathophysiology has been documented. We experienced a case of coronary artery vasospasm after atrial septal defect (ASD) surgery and then successfully treated it with both transbrachial intra-aortic balloon pump and percutaneous cardiopulmonary support. Only several hours after ASD surgery, the patient exhibited the cardiovascular collapse, the ST-segment elevation, followed by ventricular fibrillation and normal coronary angiography findings. It is important to make a differential diagnosis of coronary artery vasospasm in patients presenting with ST-segment elevation who had no notable coronary artery diseases. This case indicates that clinicians should be aware of the possibility that the coronary artery vasospasm may also occur in patients undergoing ASD surgery.

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Patients With Left Main Coronary Artery Vasospasm Inadvertently Undergoing Coronary Artery Bypass Grafting Surgery

Cited by 15 publications

References 1 publication

Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines

Unrecognized coronary vasospasm in patients referred for percutaneous coronary intervention: Intracoronary nitroglycerin, the forgotten stepchild of cardiovascular guidelines

Left Main Coronary Spasm: an Extremely Rare Entity with Possible Life-Threatening Complications

Coronary artery vasospasm after atrial septal defect surgery

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