HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Clark, D. A. Articles by Angell, W. W. Search for Related Content PubMed PubMed Citation Articles by Clark, D. A. Articles by Angell, W. W.

The Journal of Thoracic and Cardiovascular Surgery, Vol 73, 332-339, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Coronary artery spasm. medical management, surgical denervation, and autotransplantation

DA Clark, RA Quint, RL Mitchell and WW Angell

Coronary artery spasm was induced by intravascular administration of ergonovine maleate (Ergotrate) during cardiac catheterization. In 78 patients suspected to have Prinzmetal's angina, no morbidity or death has resulted despite complete occlusive spasm in two and three coronary arteries. Typical EKG changes and akinesia of the myocardium in the distribution of the occluded vessels documented functional myocardial ischemia during spasm. The occlusive spasm is readily reversed by sublingual or intravascular nitroglycerin, and ventricular contractility returns to normal following relief of spasm. Occlusive spasm has been demonstrated in 15 patients with clinical evidence of Prinzmetal's angina. Symptoms have been effectively relieved by coronary vasodilators in 10 patients. Of the 5 patients in whom medical therapy failed, 4 were treated surgically. These 4 patients were in the intensive care unit with protracted, prolonged pain, subendocardial infarctions, and persistent failure of coronary vasodilators. Aorta- coronary bypass grafts have been combined with total cardiac denervation by autotransplantation (one patient) and total cardiac denervation by stripping of the great vessels (3 patients). Two of the patients treated by cardiac denervation died in the early postoperative period. The patient treated by autotransplantation has total relief of symptoms but persistent spasm on angiography. The angiographic demonstration of occlusive coronary spasm remains a valuable diagnostic tool to document definitively the presence of spasm. The surgical results question the value of surgical intervention in this disease.

This article has been cited by other articles:

				M. J. Reardon, S. C. Malaisrie, J.-C. Walkes, A. A. Vaporciyan, D. C. Rice, W. R. Smythe, C. A. DeFelice, and Z. J. Wojciechowski Cardiac Autotransplantation for Primary Cardiac Tumors Ann. Thorac. Surg., August 1, 2006; 82(2): 645 - 650. [Abstract] [Full Text] [PDF]

				P. K. Mishra Variations in presentation and various options in management of variant angina Eur J Cardiothorac Surg, May 1, 2006; 29(5): 748 - 759. [Abstract] [Full Text] [PDF]

				H. B Erdogan, K. Kirali, S. N Omeroglu, D. Goksedef, O. Isik, and C. Yakut Partial Cardiac Autotransplantation for Reduction of the Left Atrium Asian Cardiovasc Thorac Ann, June 1, 2004; 12(2): 111 - 114. [Abstract] [Full Text] [PDF]

				J. Melo, P. Voigt, B. Sonmez, M. Ferreira, M. Abecasis, M. Rebocho, A. Timoteo, C. Aguiar, S. Tansal, H. Arbatli, et al. Ventral cardiac denervation reduces the incidence of atrial fibrillation after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 511 - 516. [Abstract] [Full Text] [PDF]

				J. Amano, A. Suzuki, and M. Sunamori Effects of cardiac denervation on coronary and systemic circulation Ann. Thorac. Surg., April 1, 1994; 57(4): 928 - 932. [Abstract] [PDF]

				M. H. Kadowaki and J. M. Levett Sympathectomy in the Treatment of Angina and Arrhythmias Ann. Thorac. Surg., May 1, 1986; 41(5): 572 - 578. [Abstract] [PDF]

				E. C. Schick Jr., Z. Davis, R. M. Lavery, J. R. McCormick, M. Fay, and R. L. Berger Surgical Therapy for Prinzmetal's Variant Angina Ann. Thorac. Surg., April 1, 1982; 33(4): 359 - 364. [Abstract] [PDF]

				E. J. SUSSMAN, S. GOLDBERG, D. S. POLL, H. MACVAUGH III, M. B. SIMSON, S. A. SILBER, and J. A. KASTOR Surgical Therapy of Variant Angina Associated with Nonobstructive Coronary Disease Ann Intern Med, June 1, 1981; 94(6): 771 - 774. [Abstract] [PDF]

				R. J. LUCHI, R. A. CHAHINE, and A. E. RAIZNER Coronary Artery Spasm Ann Intern Med, September 1, 1979; 91(3): 441 - 449. [Abstract] [PDF]

				S. J. Dos Cardiac Sympathectomy for Angina Pectoris Ann. Thorac. Surg., February 1, 1978; 25(2): 178 - 179. [PDF]