case_images: PMC10656195_01
case_images: 12-lead ECG that was taken during the vasospastic event. Findings indicated ST elevation in anterior leads V1-V3.
case_images: CRIC2023-9988680.001.jpg
case_images: PMC10656195_01_CRIC2023-9988680.001.jpg
case_images: fig1
case_images: Electrocardiogram demonstrated ST elevations in leads V1 and V2 (Figure 1), while transesophageal echocardiogram (TEE) revealed right ventricular and left ventricular inferolateral and apical wall hypokinesis (Supplement 1) with an estimated left ventricular ejection fraction (LVEF) of 30%.
case_images: Coronary angiogram of vasospasm of the left main coronary artery and its tributaries. LM: left main; LCx: left circumflex; LAD: left anterior descending; Ramus: ramus intermedius.
case_images: CRIC2023-9988680.002.jpg
case_images: PMC10656195_01_CRIC2023-9988680.002.jpg
case_images: fig2
case_images: Immediate repeat coronary angiogram showed a patent saphenous vein graft to the right coronary artery; however, all the native coronary vessels were severely and diffusely narrowed by spasms (Figures 2 and 3).
case_images: Angiogram of coronary vessels before and after vasospasm. Coronary angiogram of the left main coronary artery (a) and right coronary artery (c) preoperatively. Coronary angiogram of the left main coronary artery (b) and the right coronary artery (d) postoperative day 1. LM: left main; LCx: left circumflex; LAD: left anterior descending; Ramus: ramus intermedius; RCA: right coronary artery.
case_images: CRIC2023-9988680.003.jpg
case_images: PMC10656195_01_CRIC2023-9988680.003.jpg
case_images: fig3
case_images: Immediate repeat coronary angiogram showed a patent saphenous vein graft to the right coronary artery; however, all the native coronary vessels were severely and diffusely narrowed by spasms (Figures 2 and 3).
case_images: Coronary angiogram of the left main coronary artery and its tributaries after intracoronary administration of nitroglycerin. LM: left main; LCx: left circumflex; LAD: left anterior descending; Ramus: ramus intermedius.
case_images: CRIC2023-9988680.004.jpg
case_images: PMC10656195_01_CRIC2023-9988680.004.jpg
case_images: fig4
case_images: Nitroglycerin injected directly into the left main coronary artery transiently resolved the vasospasm (Figure 4) with improvement in left ventricular function; however, these effects were transient; therefore, VA-ECMO was continued, and an Impella 3.5 was placed across the aortic valve to help wean vasopressor requirements.