Purpose: Perioperative coronary artery occlusion is a potentially dangerous
complication causing myocardial infarction and circulatory collapse. We re
port a case showing severe ST segment depression in leads II and V5 during
anesthesia. Diltiazem and nifedipine, but not nitroglycerine, partially imp
roved the ST changes which were normalized by a percutaneous cardiopulmonar
y system (PCPS).
Clinical Features: A 71-yr-old man with cerebrovascular disease was schedul
ed for coronary artery bypass grafting(CABG). Past medical history included
myocardial infarction due to right coronary artery(RCA) occlusion. Both th
e femoral artery and vein were cannulated percutaneously before operation a
nd the PCPS was prepared as a back-up system. Depression of the ST segments
in leads V5 and II was observed following heparinization. Although hemodyn
amic stability was maintained with continuous infusion of catecholamines, t
he ST changes were not improved by intravenous nitroglycerine. Intravenous
diltiazem followed by nasal nifedipine partially improved the ST changes. T
he changes were normalized after induction of PCPS. No neurological complic
ations were observed. The postoperative coronary angiography confirmed the
total occlusion of RCA.
Conclusion: Calcium channel blockers were more effective than nitroglycerin
e in treating perioperative ST depression. However, none of them produced c
omplete reversal of the ischemic changes which were normalized with PCPS.