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J Thorac Cardiovasc Surg 2005;130:938-940
© 2005 The American Association for Thoracic Surgery

Brief Communication

Intractable postoperative internal thoracic artery spasm managed with angiographic intraluminal papaverine

Sir Charles Gairdner Hospital (SCGH, Perth, Australia), Department of Cardiothoracic Surgery, Perth, Australia.

Received for publication March 21, 2005; accepted for publication April 5, 2005.

^_* Address for reprints: Lucas H. A. Sanders FCS(SA), MD, Sir Charles Gairdner Hospital (SCGH, Perth, Australia), Department of Cardiothoracic Surgery, Hospital Ave, Nedlands, Perth, WA6007, Australia (Email: lucmedi@hotmail.com).

The first 20% of the full text of this article appears below.

Spasm of the left internal thoracic artery (LITA) and native coronary artery in the immediate postoperative period represents a life-threatening complication. Successful treatment with papaverine injected intraluminally by angiographic catheterization has not previously been reported. We present such a case.

Clinical Summary

An 84-year-old woman underwent sequential grafting of the first diagonal and left anterior descending coronary artery (LAD) with a pedicled, nonskeletonized left internal thoracic artery (LITA). The procedure was performed without the aid of cardiopulmonary bypass with an Octopus IV Tissue Stabilizer (Medtronic, Inc, Minneapolis, Minn). Preoperative angiography revealed sequential 50% and 70% LAD and 90% first diagonal stenoses. The right coronary artery was blocked with a small distal vessel to an inferior infarct, well collateralized from the left. Left ventricular function was mildly impaired because of inferior akinesia. Interestingly, left ventriculography revealed hypercontractility in its midportion, resulting in a double-chamber–like image. The patient's history included hypertension, hypercholesterolemia, and peptic ulcer disease. She had stopped smoking . . . [Full Text of this Article]

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