Analgésie et réanimation : recherche actuelle

Coronary Vasospasm Following David Intervention

Ruben Jara Rubio, M Martinez Martinez, C Albacete Moreno, E Garcia Garcia, SJ Canovas Lopez, D Bixquert Genoves, E Pinar Bermudez

 Coronary Vasospasm Following David Intervention

Background: Ventricular arrhythmias following cardiac surgery are uncommon but may be fatal. Early identification and treatment are crucial for survival. Different causes like electrolyte imbalance, ischemia, graft closure or technical complications must be detected.
Methods: We present a case of a patient who suffered ventricular fibrillation in the first hour after cardiac surgery for aortic regurgitation.
Results: A 38 year old male with Marfan syndrome and aortic regurgitation was admitted following a modified Davids reimplantation procedure. One hour later, ventricular fibrillation required 9 cardioversions to restore sinus rhythm. ECG showed a 2 mm elevation in V3. Coronary angiography showed a left anterior descending coronary artery vasospasm, resolved with intracoronary nitroglycerin. Calcium antagonists were started with no recurrence of arrhythmia; one week later he was discharged from hospital with no disabilities.
Conclusion: Coronary spastic angina has been demonstrated among patients with connective tissue diseases. Vasospasm may lead to ventricular arrhythmias after cardiac surgery. In patients with previous history of chest pain, treatment with vasodilators may prevent coronary artery vasospasm.