In-situ Internal-thoracic-artery Grafting for a Patient with Medically Intractable Coronary Spasm and Angiographically Normal Coronary Arteries

摘要

A 58-year-old woman presented with a six-month history of recurrent chest pain, ventricular arrhythmia, and circulatory collapse. Coronary angiography revealed normal coronary arteries with no evidence of atherosclerotic change. Ergonovine provoked severe spasm of the right main coronary artery accompanied by ST-segment elevation and complete A-V block. She underwent bypass surgery, in which in-situ right internal-thoracic-artery (ITA) was placed distal to the portion of right main coronary artery. After the operation, she quickly attained symptom-free. Postoperative angiography demonstrated that, during the ergonovine provocation lest, in-situ ITA graft supplied sufficient blood flow in the distal coronary artery, preventing chest pain and ventricular arrhythmia. The patient remained event-free more than three years later. In-situ ITA grafting is warranted among patients with medically intractable coronary spasm and angiographically normal coronary arteries.