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Multivessel coronary artery vasospasm masquerading as surgical coronary atherosclerotic disease
Author(s) -
Singh Navneet,
Nand Parma
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15866
Subject(s) - medicine , cardiology , coronary artery disease , vasospasm , chest pain , coronary vasospasm , asystole , angina , extracorporeal membrane oxygenation , artery , surgery , myocardial infarction , subarachnoid hemorrhage
Background and Aim: We report a case of a 39‐year‐old lady presenting with worsening angina. Materials and Methods: This is a case report study. Clinical case data was retrieved from hospital paper and electronic records. Results: Invasive coronary angiography revealed disease in the left main stem, proximal left anterior descending (LAD) artery and circumflex artery. The patient proceeded to on‐pump coronary artery bypass grafting. Intraoperatively, there were multiple unsuccessful attempts to wean off cardiopulmonary bypass. An on‐table angiogram—which initially triggered asystole requiring internal cardiac massage and institution of venoarterial extracorporeal membrane oxygenation (ECMO)— showed no native coronary artery disease. Instead, this angiogram revealed severe vasospasm with narrowing in the grafts and distal LAD. The patient received calcium channel blockers and bilateral thoracic sympathectomies to suppress any further coronary vasospasm. She was subsequently successfully weaned off ECMO. Discussion and Conclusion: This case reveals the life‐threatening nature and diagnostic dilemma posed by severe multivessel coronary vasospasm. We also highlight the novel role of thoracic sympathectomy for definitive management of refractory vasospastic angina.