PERIOPERATIVE CORONARY-ARTERY SPASM IN MODIFIED BENTALLS OPERATION FOR ANNULOAORTIC ECTASIA IN MARFANS-SYNDROME - A CASE-REPORT OF PERIOPERATIVE CHORDAL RUPTURE OF THE MITRAL-VALVE

We experienced a rare case of Marfan's syndrome with annulo-aortic ect asia, aortic regurgitation and Prinzmetal's variant angina, In a modif ied Bentall's operation (button technique), perioperative severe coron ary artery spasm occurred in spite of the preventive use of nitroglyce rin infusion, which resulted in profound ventricular fibrillation and subsequent chordal rupture of the mitral valve with Sellers IV regurgi tation, Use of nicardipine contained in cardioplegia, continuous infus ion of nicardipine and nitroglycerin after aortic declamping completel y prevented coronary spasm throughout the course of a second surgery f or mitral valve replacement. It is worthy to report this case because of rarities such as Marfan's syndrome accompanied by Prinzmetal's vari ant angina, perioperative coronary artery spasm in modified Bentall's operation, and perioperative chordal rupture of the mitral valve and p rogression of mitral valve regurgitation, We also stress the efficacy of a new calcium antagonist, nicardipine, to prevent coronary artery s pasm during open heart surgery.