| Abstract: | A 58 year old man presented with Prinzmetal's variant angina. Recurrent ventricular tachyarrhythmias, uncontrolled by various medical regimens, prompted cardiac catheterization. At catheterization a congenital anomaly of the coronary circulation was demonstrated, consisting of a single coronary artery. During coronary angiography, arterial spasm occurred associated with chest pain and ventricular ectopic beats. This was relieved by the acute administration of sublingual nitrates. Subsequently, despite the frequent administration of nitroglycerin and isosorbide dinitrate, chest pain and ventricular tachycardia continued to occur sporadically. Because of this, saphenous vein bypass surgery was performed. After an initial symptom-free interval, the chest pain recurred. Recatheterization revealed complete occlusion of the distal circumflex artery at the insertion of the implanted saphenous vein. The use of aortocoronary saphenous vein bypass grafting for relief of symptomatic coronary arterial spasm is questioned. |
