Surgical treatment of valvular disease with spasm of the coronary artery
Sakakibara, T.; Hirose, H.; Nakano, S.; Matsuda, H.; Kawashima, Y.
Nihon Kyobu Geka Gakkai 34(8): 1182-1188
1986
ISSN/ISBN: 0369-4739 PMID: 3491169 Document Number: 285124
In this paper, we present our experiences with surgical treatment of two patients with acquired valvular disease accompanied by coronary artery spasm. The first case is a 65-year-old man who complained of exersional dyspnea and nocturnal rest angina. Cardiac catheterization, angiocardiography and echocardiography showed a severely stenotic mitral valve and spasm of the coronary artery. He underwent open mitral commissurotomy. The early postoperative course was uneventful. However, 4 and 5 hours after operation, he suddenly encountered ventricular fibrillation and cardiac arrest following ST elevation on electrocardiography. He was resuscitated with success by open cardiac massage and bolus injection of protanol in the aortic root. Hemodynamic state was stable after those events. Thirteen months after operation, he was free from symptom of cardiac failure and angina pectoris. The second case is a 52-year-old man undergoing mitral valve replacement 7 years ago. He had exersional dyspnea and nocturnal rest angina. Aortography showed severe aortic regurgitation. And also coronary arteriography revealed that spasm of the left coronary artery was provocated by administration of ergonovine, stenosis of left anterior descending artery (LAD) and obtuse marginal branch were appeared. He underwent aortic valve replacement and single saphenous vein graft to LAD under continuous infusion of diltiazem. Postoperative course was uneventful and no electrocardiographic change occurred. Three months after operation, he was doing well without limit of activity.