J Korean Soc Transplant.  2016 Sep;30(3):143-147. 10.4285/jkstn.2016.30.3.143.

Recurrent Cardiac Arrest during a Nontransplant Operation Due to Variant Angina in a Liver Transplantation Patient

• Yang J
• Kim DY
• Lee SK
• Kim G

• KMID: 2354639
• DOI: http://doi.org/10.4285/jkstn.2016.30.3.143

Abstract

We report a case of recurrent cardiac arrest during a nontransplant operation in a liver transplant recipient with prior cardiac arrest during liver transplantation. A 45-year-old man who experienced cardiac arrest for 17 minutes during the preanhepatic phase of liver transplantation-which was performed 34 months ago-did not survive the recurrent cardiac arrest during portal venoplasty. Variant angina was not suspected for the first cardiac arrest; however, myocardial infarction by coronary vasospasm was revealed to be the cause of the second cardiac arrest.

Keyword

Liver transplantation; Heart arrest; Variant angina

MeSH Terms

Coronary Vasospasm
Heart Arrest*
Humans
Liver Transplantation*
Liver*
Middle Aged
Myocardial Infarction
Transplant Recipients

Figure

• 

  Fig. 1. Postoperative right coronary angiography in the left anterior oblique view. (A) Baseline right coronary angiography. (B) Right coronary angiography after intracoronary ergonovine injection. The arrows indicate diffuse coronary spasm of the right coronary artery induced by ergonovine. (C) Coronary spasm of the right coronary artery was reversed by intracoronary nitroglycerine injection.

Reference

1). Baik SK., Fouad TR., Lee SS. Cirrhotic cardiomyopathy. Orphanet J Rare Dis. 2007. 2:15.

2). Moller S., Henriksen JH. Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease. Heart. 2002. 87:9–15.

3). Prinzmetal M., Kennamer R., Merliss R., Wada T., Bor N. Angina pectoris. I. A variant form of angina pectoris: preliminary report. Am J Med. 1959. 27:375–88.

4). Fontaine B., Bertrandias E., Chelly J., Kieffer JP., Tournay D., Peyrat D, et al. Prinzmetal's angina during myocardial revascularisation. Cardiovascular complications in 71 patients (author's transl). Anesth Analg (Paris). 1979. 36:545–50.

5). Bory M., Pierron F., Panagides D., Bonnet JL., Yvorra S., Desfossez L. Coronary artery spasm in patients with normal or near normal coronary arteries. Long-term follow-up of 277 patients. Eur Heart J. 1996. 17:1015–21.

6). Beltrame JF., Crea F., Kaski JC., Ogawa H., Ong P., Sechtem U, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2015 Aug 4. [Epub].DOI: doi: http://dx.doi.org/10.1093/eurheartj/ehv351.

7). Inazumi T., Shimizu H., Mine T., Iwasaki T. Changes in autonomic nervous activity prior to spontaneous coronary spasm in patients with variant angina. Jpn Circ J. 2000. 64:197–201.

8). Stern S., Bayes de Luna A. Coronary artery spasm: a 2009 update. Circulation. 2009. 119:2531–4.

9). Nakano T., Osanai T., Tomita H., Sekimata M., Homma Y., Okumura K. Enhanced activity of variant phospholipase C-delta1 protein (R257H) detected in patients with coronary artery spasm. Circulation. 2002. 105:2024–9.

10). Green MS., Gomes S. Intraoperative coronary artery vasospasm: a twist in the tale! Middle East J Anaesthesiol. 2011. 21:299–304.

11). Fujita Y., Sasaki Y., Endoh E., Kimura K., Fukui A., Ohsumi A, et al. Intraoperative coronary artery spasm during non-coronary artery surgery. J Cardiothorac Anesth. 1990. 4:740–3.

12). Zainea M., Duvernoy WF., Chauhan A., David S., Soto E., Small D. Acute myocardial infarction in angiographically normal coronary arteries following induction of general anesthesia. Arch Intern Med. 1994. 154:2495–8.

13). Kindgen-Milles D., Vester EG., Muller EE. Intra- and postoperative myocardial ischemia without significant coronary artery stenosis. Acta Anaesthesiol Scand. 1998. 42:478–80.

14). Sidi A., Dahleen L., Gaspardone A. Coronary vasospasm during anesthesia induction: awareness, recognition, possible mechanisms, anesthetic factors, and treatment. J Clin Anesth. 2008. 20:64–9.

15). Hayashida M., Matsushita F., Suzuki S., Misawa K. Coronary artery spasm immediately after the long-standing operation for cancer of the tongue. Masui. 1992. 41:1986–90.

16). Crea F., Chierchia S., Kaski JC., Davies GJ., Margonato A., Miran DO, et al. Provocation of coronary spasm by dopamine in patients with active variant angina pectoris. Circulation. 1986. 74:262–9.

17). Yasue H., Touyama M., Shimamoto M., Kato H., Tanaka S. Role of autonomic nervous system in the pathogenesis of Prinzmetal's variant form of angina. Circulation. 1974. 50:534–9.

18). Rubenstein MD., Wall RT., Baim DS., Harrison DC. Platelet activation in clinical coronary artery disease and spasm. Am Heart J. 1981. 102(3 Pt 1):363–7.

19). Hirabayashi Y., Saitoh K., Fukuda H., Mitsuhata H., Shimizu R. Coronary artery spasm after ephedrine in a patient with high spinal anesthesia. Anesthesiology. 1996. 84:221–4.

20). Fuse K., Makuuchi H., Konishi T., Nakanishi S., Nishiyama S., Nishimura S, et al. Coronary artery spasm during coronary artery bypass surgery: its diagnosis, treatment and prevention. Jpn J Surg. 1988. 18:626–35.

21). Truong AT., Truong DT., Brown DL. Recurrent intraoperative coronary artery spasm in a patient with coronary artery aneurysm. J Clin Anesth. 2006. 18:530–3.

22). Kwok OH., Chow WH., Chiu SW. Coronary artery spasm of a non-culprit vessel during off-pump bypass surgery. Asian Cardiovasc Thorac Ann. 2004. 12:91.

23). Choi SS., Lim YJ., Bahk JH., Do SH., Ham BM. Coronary artery spasm induced by carotid sinus stimulation during neck surgery. Br J Anaesth. 2003. 90:391–4.

24). Nagaoka H., In-nami R., Funakoshi N., Fujiwara A., Ito A., Iesaka Y, et al. Successfully treated intraoperative coronary artery spasm in a patient with type B dissecting aortic aneurysm: a case report. Kyobu Geka. 1992. 45:619–22.

25). Biyik I., Akturk IF., Yalcin AA., Celik O., Oner E. Immunosuppressive therapy induced coronary vasospasm and acute myocardial infarction in a patient undergoing new renal transplantation. Postepy Kardiol Interwencyjnej. 2015. 11:141–5.

26). Santoro F., Lopizzo A., Centola A., Cuculo A., Ruggiero A., Di Biase M, et al. Very late coronary spasm inducing acute myocardial infarction in a heart transplant recipient. J Cardiovasc Med (Hagerstown). 2014 Jul 10. [Epub].DOI: doi: http://dx.doi.org/10.2459/JCM.0000000000000049.

27). Ferguson ME., Pearce FB., Hsu HH., Misra VK., Kirklin JK. Coronary artery spasm during angiography in a pediatric heart transplant recipient: subsequent prevention by intracoronary nitroglycerin administration. Tex Heart Inst J. 2010. 37:469–71.

28). Jeanmart H., Malo O., Carrier M., Nickner C., Desjardins N., Perrault LP. Comparative study of cyclosporine and tacrolimus vs newer immunosuppressants mycophenolate mofetil and rapamycin on coronary endothelial function. J Heart Lung Transplant. 2002. 21:990–8.

29). Textor SC., Wiesner R., Wilson DJ., Porayko M., Romero JC., Burnett JC Jr, et al. Systemic and renal hemodynamic differences between FK506 and cyclosporine in liver transplant recipients. Transplantation. 1993. 55:1332–9.

30). Lanza GA., Careri G., Crea F. Mechanisms of coronary artery spasm. Circulation. 2011. 124:1774–82.

31). Umphrey LG., Hurst RT., Eleid MF., Lee KS., Reuss CS., Hentz JG, et al. Preoperative dobutamine stress echocardiographic findings and subsequent short-term adverse cardiac events after orthotopic liver transplantation. Liver Transpl. 2008. 14:886–92.

32). Fleisher LA., Fleischmann KE., Auerbach AD., Barnason SA., Beckman JA., Bozkurt B, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014. 64:e77–137.

33). Ripoll C., Catalina MV., Yotti R., Olmedilla L., Perez-Pena J., Lo Iacono O, et al. Cardiac dysfunction during liver transplantation: incidence and preoperative predictors. Transplantation. 2008. 85:1766–72.

34). Matsusaki T., Hilmi IA., Planinsic RM., Humar A., Sakai T. Cardiac arrest during adult liver transplantation: a single institution's experience with 1238 deceased donor transplants. Liver Transpl. 2013. 19:1262–71.

35). Ertel AE., Wima K., Chang AL., Hoehn RS., Hohmann SF., Edwards MJ, et al. Risk of reoperation within 90 days of liver transplantation: a necessary evil? J Am Coll Surg. 2016. 222:419–28.