Native right coronary artery (RCA) spasm is a less frequent early complication of perioperative coronary artery bypass grafting. Late presentation at 6 days postoperation is scarce and its relationship with an anomalous coronary artery is unknown. The optimal management and prevention remains controversial. In the case presented, the patient’s anomalous left coronary artery originating from the right coronary cusp underwent ligation at its proximal segment at the time of bypass grafting. This ligation was preformed to prevent competitive flow. Six days postoperation, a refractory spasm of dominant native RCA occurred. The spasm resulted in right ventricular failure. Administration of intracoronary verapamil had a longer sustained vasodilatory effect and resolution of coronary spasm when compared with intracoronary nitroglycerine injection. An intra-aortic balloon pump, inotropic agents and low-dose nitroglycerine were used to maintain adequate haemodynamic support. Right ventricular systolic function recovery was noted within 2 days postintervention.
- cardiothoracic surgery
- interventional cardiology
- heart failure
- ischaemic heart disease
- cardiovascular system
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Contributors HZ conceptualised the design of the manuscript. HZ and RKB both drafted the manuscript and revised the work for important intellectual content. HZ, RKB, and VAM participated in clinical work presented in this manuscript. HZ, RKB, and VAM approved the final version of the paper that has been submitted and are in agreement to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Next of kin consent obtained.
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