LETHAL POSTOPERATIVE CORONARY-ARTERY SPASM

Background. Coronary artery spasm in the immediate postoperative perio d after a coronary operation is recognized infrequently. Its severity is variable and manifestations unpredictable. The diagnosis is usually made by an awareness of the possibility and thereafter by exclusion o f other causes of myocardial ischemia. An opportunity for a positive d iagnosis is rarely available. Methods. The case reports of 3 patients with similar presentations of ischemic heart disease and with severe m anifestations of coronary artery spasm in the postoperative period are presented. Results. All 3 patients were women aged 55 to 60 years. Al l had single-vessel coronary artery disease involving the left anterio r descending artery and underwent a left internal mammary artery bypas s graft. Severe manifestations of myocardial ischemia of abrupt onset developed approximately 7 hours postoperatively in each patient. One p atient died of severe hemodynamic deterioration from which resuscitati on was unsuccessful. Another sustained a large anterior myocardial inf arction despite graft patency. The third patient was supported by an i ntraaortic balloon pump and made a full recovery. Conclusions. The ear ly diagnosis of coronary artery spasm is achieved by an awareness of t he condition. The institution of early appropriate management may prev ent its consequences. (C) 1998 by The Society of Thoracic Surgeons.