Coronary artery spasm during coronary artery bypass surgery: Its diagnosis,treatment and prevention |
| |
Authors: | Katsuo Fuse MD Haruo Makuuchi Toshio Konishi Shigemoto nkkanishi Shinichiro Nishiyama Yasuyuki Hosoda Hiroshi Yamaguchi |
| |
Institution: | (1) Division of Cardiovascular Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, 105 Tokyo, Japan;(2) The Department of Thoracic Surgery, Juntendo University, Tokyo, Japan;(3) Department of Cardiology, Juntendo University, Tokyo, Japan |
| |
Abstract: | Between 1982 and 1983, we experienced four cases of hemodynamic collapse accompanied by an ST-segment depression in the ECG
lead II, shortly after the cessation of cardiopulmonary bypass. The bypass graft flows monitored in these patients during
the hemodynamic collapse episodes were remarkably low. In three cases, nitroglycerin (0.5–1 mg) was injected directly into
the vein graft, which increased the graft flow suddenly, returned the ST-segment to the baseline, and improved the circulatory
condition. Since 1984, however, diltiazem has been used in the cardioplegic solution and postoperative drip infusion. Due
to the introduction of this drug, coronary artery spasm has not been seen in any of our patients since. These findings show
that the monitoring of ST-segment changes and bypass graft flows are useful in the early diagnosis of coronary artery spasm
after myocardial revascularization. Direct infusion of nitroglycerin into the vein graft is effective for the treatment of
spasm, while diltiazem is useful in the prevention of coronary artery spasm incidental to myocardial revascularization. |
| |
Keywords: | myocardial revascularization intraoperative coronary artery spasm graft flow nitroglycerin diltiazem |
本文献已被 SpringerLink 等数据库收录! |
|