Diffuse refractory coronary artery spasm after off-pump coronary artery bypass grafting: a case series

• Published in: Ain-Shams journal of anesthesiology Vol. 15; no. 1; pp. 16 - 5
• Main Authors: Abraham, Benson, Nair, Kannan Ramachandran, Sulaiman, Sajith
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 27.03.2023; Springer Nature B.V; SpringerOpen
• Subjects: Calcium channel blockers; Cardiac arrhythmia; Case Report; Coronary angiography; Coronary artery bypass grafting; Coronary artery spasm; Coronary vessels; Critical Care Medicine; Electrocardiogram; Heart surgery; Intensive; Intraaortic balloon pump; Medicine; Medicine & Public Health; Stents; Surgery; Intraaortic balloon pump; Coronary angiography; Coronary artery bypass grafting; Calcium channel blockers; Electrocardiogram; Coronary artery spasm
• ISSN: 2090-925X; 1687-7934; 2090-925X
• DOI: 10.1186/s42077-023-00313-x

Background Diffuse coronary artery spasm after coronary artery bypass grafting may cause disastrous circulatory collapse and death if not detected and managed promptly. Case presentation Four out of 387 patients who underwent uneventful off-pump coronary artery bypass grafting between January 2019 and December 2021 at our centre developed unexplained arrhythmias and hypotension within 2 to 6 h of the postoperative period. Coronary angiogram showed diffuse coronary vasospasm involving both grafted and ungrafted native coronary arteries. Vasospasm was refractory to intracoronary vasodilators in all these cases. All of the patients recovered completely with the use of intravenous verapamil infusion and intraaortic balloon pump support. Conclusions Coronary artery spasm should remain in the differential diagnosis in patients developing unexplained arrhythmias and haemodynamic instability following coronary artery bypass grafting. Prompt diagnosis with coronary angiogram and proper management strategy using calcium channel blockers and intraaortic balloon pump can revert this deadly complication. Surgical intervention may delay precious time needed for therapeutic intervention.