Ann Thorac Surg 1988;46:108-115
© 1988 The Society of Thoracic Surgeons
Coronary Artery Spasm Following Coronary Artery Surgery
John H. Lemmer, Jr., M.D.*, Marvin M. Kirsh, M.D.
Division of Cardiothoracic Surgery, the University of Iowa Hospital, Iowa City, IA, and the Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI
* Address reprint requests to Dr. Lemmer, Division of Cardiothoracic Surgery, The University of Iowa Hospitals and Clinics, Rm 2033, Boyd Tower, Iowa City, IA 52242
Coronary artery spasm during the early postoperative period following cardiopulmonary bypass for coronary artery surgery can be an unrecognized cause of sudden, severe cardiopulmonary collapse. The literature regarding perioperative coronary artery spasm is reviewed, and methods of prevention, diagnosis, and treatment are suggested. Preoperative angina at rest appears to be an important identifying factor in patients who experience postoperative coronary spasm. Anatomically, the presence of a relatively normal, dominant right coronary may also indicate increased risk for early post-coronary bypass spasm. Acute hypotension is often the first sign of coronary artery spasm, and conventional treatment methods may only worsen the vasospastic reaction. Peripheral intravenous nitroglycerin infusion has often been unsuccessful treatment while intragraft or intracoronary nitroglycerin injection or administration of calcium channel-blocking drugs, or both, has proven to be effective in reversing the coronary artery spasm and ventricular dysfunction. Reluctance to use vasodilating agents must be overcome, even in the face of hypotension, when evidence of spasm is present.