Post-valvular surgery multi-vessel coronary artery spasm — A literature review

Abstract

Coronary artery spasm (CAS) refers to the spontaneous or stimuli-induced transient, often localized and intense subtotal or total constriction/occlusion of the epicardial coronary artery, usually concomitant with angina pectoris with associated elevation of the ST segment on electrocardiogram (ECG).In this article, we present a literature review on post-valvular surgery CAS and report the clinical case of a 77 year-old man who experienced severe early post-aortic surgery chest pain and hemodynamic instability. Emergent coronary angiography revealed severe occlusion of multiple branches of both coronary arteries. The CAS was alleviated with intracoronary infusion of nitroglycerin.

Refractory diffuse coronary artery spasm post aortic valve replacement

“…Most cases of postoperative CAS are reported post-coronary artery bypass surgery; however, a few post-valvular surgery cases, such as after AVR, have also been reported. Pragliola et al and Formica et al summarized previous cases of coronary spasm after valve replacement, most of which were right coronary artery only or diffuse [ 1 , 2 ]. Once confirmed by angiography from collapse or electrocardiogram changes, CAS treatment, direct intracoronary injection of nitrates or calcium channel blockers, is usually effective.…”