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J Thorac Cardiovasc Surg 2007;133:1649-1650
© 2007 The American Association for Thoracic Surgery

Brief Communication

Successful management of unremitting spasm of the nongrafted right coronary artery after off-pump coronary artery bypass grafting

Stefano Schena, MD, PhDa, Troy Wildes, MDb, Michael A. Beardslee, MDc, John M. Lasala, MD, PhDc, Ralph J. Damiano, Jr, MDa, Jennifer S. Lawton, MDa,*

a Division of Cardiothoracic Surgery, Washington University School of Medicine and Barnes–Jewish Hospital, St Louis, Mo, USA
b Department of Anesthesiology, Washington University School of Medicine and Barnes–Jewish Hospital, St Louis, Mo, USA
c Division of Cardiology, Washington University School of Medicine and Barnes–Jewish Hospital, St Louis, Mo, USA.

* Address for reprints: Jennifer S. Lawton, MD, Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8234, St Louis, MO 63110-1013. (Email: lawtonj@wustl.edu).

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

Coronary artery spasm may complicate the immediate postoperative period after coronary artery bypass grafting (CABG). Spasm has also been described as occurring after off-pump CABG (OPCAB) and has been attributed to both technical and iatrogenic causes. In reported cases, removal of the causative factor or intracoronary nitroglycerine has eliminated the spasm. To our knowledge, this is the first report of a patient who underwent successful OPCAB and experienced a persistent spasm of the nongrafted right coronary artery despite intracoronary administration of nitroglycerine and nicardipine. Cardiogenic shock was improved only after emergent insertion of an intra-aortic balloon pump (IABP) and extensive angioplasty and stenting of the involved vessel.

Clinical Summary

A 49-year-old man, who had percutaneous transluminal coronary angioplasty and stent to the proximal left anterior descending artery (LAD) 5 months previously, presented with recurrent angina and 60% in-stent stenosis with extension into the left main and compromise of the ostial left circumflex artery. A 30% eccentric . . . [Full Text of this Article]




This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
P. Saxena, I. E. Konstantinov, and M. A.J. Newman
Severe vasospasm in off-pump coronary artery bypass surgery: a difficult clinical problem.
J. Thorac. Cardiovasc. Surg., November 1, 2007; 134(5): 1380 - 1381.
[Full Text] [PDF]


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