Key result
Right coronary artery spasm triggers severe perioperative ischemia, cardiac arrest, and AV block during aneurysm repair.
Why the study?
Myocardial ischemia can occur intra- and postoperatively without significant coronary artery stenosis, but its mechanisms and clinical course require clarification.
Case Report (n=1)
Spontaneous perioperative ST elevations may precede VF arrest without instability in AAA repair; leaves open need for enhanced ECG surveillance in vascular cases.
A 73-year-old man without a history of coronary artery disease had two episodes of significant ST-segment elevation indicative of inferior myocardial ischemia during the resection of an abdominal aortic aneurysm. During the further course, sudden ST-segment elevations occurred and resolved spontaneously without preceding hemodynamic instability. The patient sustained two episodes of cardiac arrest due to ventricular fibrillation and intermittent third-degree atrioventricular block with ventricular asystole. On cardiac catheterization, coronary arteries had a right dominant pattern. The right coronary artery was entirely patent on multiple injections. Thus, right coronary artery spasm is the only possible explanation for these observations.
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Kindgen‐Milles et al. (1998) conducted a case report in Myocardial ischemia without significant coronary artery stenosis (n=1). Right coronary artery spasm was evaluated. Right coronary artery spasm caused severe intra- and postoperative myocardial ischemia, cardiac arrest, and atrioventricular block during abdominal aortic aneurysm resection in a 73-year-old man.
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