Recurrent intraoperative coronary artery spasm in a patient with coronary artery aneurysm

Coronary artery spasm (CAS) may result from endothelial dysfunction in nonobstructed arteries. Its complications include myocardial infarction, dysrhythmias, and death. It is difficult to diagnose CAS during general anesthesia because it closely mimics obstructive ischemia. We report the case of a patient who demonstrated intraoperative CAS during two separate surgeries. Angiography after the first surgery showed nonobstructed coronary anatomy. During the second surgery, recurrence of acute ST elevations caused by CAS rapidly responded to nitroglycerin. A high index of suspicion for CAS as a cause of intraoperative ischemia is necessary for an early diagnosis, treatment, and a favorable outcome.