冠動脈バイパス移植後の在来型冠動脈系の大量冠攣縮。転帰が異なる2例

Massive coronary spasm of the native coronary system after coronary artery bypass grafting: Two patients with different outcomes.

• Matej Ondrusek
• Panagiotis Artemiou
• Ivan Glonek
• Michal Hulman

抄録

冠動脈バイパスグラフト術後，術後すぐに在来型冠動脈系の大規模な痙攣を発症した2例について，異なる転帰を示した症例を報告する。最初の患者は血行動態が安定しており、異なるリードにおける虚血性心電図変化（ST上昇または抑圧）が認められた。冠動脈内投与とニトログリセリンとカルシウム拮抗薬の静脈内投与を行い，良好な転帰を得た．2例目は中心静脈動脈外膜酸素化術を留置した後、多臓器不全と出血性ショックにより死亡した。

We report the cases of two patients who developed a massive spasm of the native coronary system in the immediate postoperative period, following a coronary artery bypass grafting operation with different outcomes. The first patient was hemodynamic stable and it was manifested as ischemic electrocardiographic changes in different leads (ST elevation or depression). He was treated with intracoronary and intravenous administration of nitroglycerin and calcium channel blocker and had a favorable outcome. The second patient died due to multiorgan failure and hemorrhagic shock, after the implantation of a central venoarterial extracorporeal membrane oxygenation.

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