Post-valvular surgery multi-vessel coronary artery spasm — A literature review

• Postvalvular surgery coronary artery spasm (CAS) is a multifactorial, infrequent but lethal open heart surgery complication.
• Despite its multifactorial mechanistic underlining, there is no universal prophylactic or definitive treatment for CAS.
• CAS is a recognized culprit in perioperative agina, acute myocardial infarction and associated hemodynamic instability.
• Optimal therapeutic strategy for postoperative CAS continues to evolve.
• There is need for globally standardized diagnostic and therapeutic protocol, with continued research of CAS pathomechanism.

Coronary artery spasm (CAS) refers to the spontaneous or stimuli-induced transient, often localized and intense subtotal or total constriction/occlusion of the epicardial coronary artery, usually concomitant with angina pectoris with associated elevation of the ST segment on electrocardiogram (ECG).In this article, we present a literature review on post-valvular surgery CAS and report the clinical case of a 77 year-old man who experienced severe early post-aortic surgery chest pain and hemodynamic instability. Emergent coronary angiography revealed severe occlusion of multiple branches of both coronary arteries. The CAS was alleviated with intracoronary infusion of nitroglycerin.