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Ann Thorac Surg 1999;67:892-893
© 1999 The Society of Thoracic Surgeons

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Correspondence

Unexpected complications of postcoronary operation: the role of intracoronary ultrasound

^a Department of Cardiac Surgery,, Al Hada Armed Forces Hospital, P.O. Box 1347, Taif, Saudi Arabia

To the Editor

We read with interest the articles on coronary artery spasm [1, 2], a condition that remains one of the main causes of intraoperative or immediately postoperative morbidity and mortality after exclusion of graft or anastomotic dysfunction and with adequate myocardial preservation.

This problem is seen mainly in patients with single or double vessel disease, and the electrocardiographic ischemic changes are usually in the nongrafted area. Hypothermia, small coronary arteries, and an underlying atherosclerotic disease are the main factors contributing to spasm. Paterson and associates [1] reported three patients with lethal postoperative coronary spasm. All were female, which might add another cause to the higher risk of coronary operations in female patients.

Topical papaverine, intravenous nitroglycerin, and calcium-channel blockers might help to treat pure coronary artery spasm with no underlying coronary atherosclerosis. Internal mammary artery spasm is best avoided by meticulous no-touch surgical dissection. Recently we used the ultracision scalpel (Harmonic scalpel; Ultracision, Inc., Smithfield, RI) in harvesting the radial and the internal mammary arteries to reduce the incidence of conduit spasm.

An underlying, nonangiographically imaged, significant coronary disease might contribute to coronary spasm, but rarely does pure vasospasm occur [3, 4]. Recently intracoronary ultrasound was introduced as an alternative technique or an important adjunct to visualize and evaluate the severity of coronary disease. It can identify unanticipated high-grade stenosis as it gives 360-degree tomographic views of cross-sectional coronary anatomy in contrast to the biplane angiographic views.

In conclusion, coronary surgeons should be aware of these possibilities, and a study is needed to evaluate the role and indications of intracoronary ultrasound.

References

1. Paterson H.S., Jones M.W., Baird D.K., Huges C.F. Lethal postoperative coronary spasm. Ann Thorac Surg 1998;65:1571-1573.[Abstract/Free Full Text]
2. Lemmer J.H., Kirsh M.M. Coronary artery spasm following coronary artery surgery. Ann Thorac Surg 1988;46:108-115.[Abstract]
3. Pirolo J., Fredi J., Shuman T. Intracoronary ultrasound–guided CABG in patients with angiographically noncritical lesions. Ann Thorac Surg 1997;64:375-379.[Abstract/Free Full Text]
4. Ehrlich S., Honye J., Mahon D., et al. Unrecognized stenosis by angiography documented by intravascular ultrasound imaging. Cathet Cardiovasc Diag 1991;23:198-201.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Khalid E. Al-Ebrahim Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Al-Ebrahim, K. E. Articles by Shafei, H. Search for Related Content PubMed Articles by Al-Ebrahim, K. E. Articles by Shafei, H.