What is the clinical evidence from this study?

Study design: Case Report. Population: Coronary artery spasm during aortic valve replacement (n=1). Intervention: Intracoronary nitroglycerin and intra-aortic balloon pump (IABP).

What question did this study set out to answer?

This report aims to highlight the occurrence of coronary artery spasm after aortic valve replacement and its diagnosis.

April 25, 2026Open Access

Coronary artery spasm during aortic valve replacement diagnosed by transesophageal echocardiography: A case report

Key Result

Intracoronary nitroglycerin and intra-aortic balloon pump support successfully resolved severe coronary artery spasm and refractory ventricular fibrillation during aortic valve replacement.

Key Points

This report aims to highlight the occurrence of coronary artery spasm after aortic valve replacement and its diagnosis.
Case report of a 59-year-old male undergoing mechanical aortic valve replacement.
Intraoperative transesophageal echocardiography and emergency coronary angiography were utilized for diagnosis and treatment.
Intracoronary nitroglycerin was administered for spasm relief.
ST-segment elevation and ventricular fibrillation occurred post-surgery; diagnosed via echocardiography.
Coronary angiography confirmed diffuse spasm in left anterior descending and right coronary arteries.
Patient stabilized with intracoronary nitroglycerin and was discharged in good condition.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

59-year-old male with severe aortic regurgitation and aneurysmal dilation of the ascending aorta (NYHA class II-III) undergoing mechanical aortic valve replacement

Intervention

Intraoperative transesophageal echocardiography monitoring of coronary ostial blood flow, followed by emergency coronary angiography, intracoronary nitroglycerin, and intra-aortic balloon pump (IABP) support in a hybrid operating room

Outcome

Diagnosis and relief of coronary artery spasm and hemodynamic stabilization

Intraoperative transesophageal echocardiography monitoring of coronary ostial flow in a hybrid operating room facilitates rapid diagnosis and life-saving intervention for coronary artery spasm during cardiac surgery.

Limitations

Single case report
Kounis syndrome cannot be completely excluded as a potential mechanism

Abstract

Coronary artery spasm (CAS) after non-coronary cardiac surgery is rare but potentially life-threatening and may mimic acute coronary obstruction or surgical complications. A 59-year-old male with severe aortic regurgitation underwent mechanical aortic valve replacement in a hybrid operating room. After weaning from cardiopulmonary bypass, the patient developed recurrent ST-segment elevation and refractory ventricular fibrillation. Intraoperative transesophageal echocardiography demonstrated transient disappearance of blood flow at the right coronary artery ostium during ischemic episodes. Emergency coronary angiography confirmed diffuse coronary artery spasm involving both the left anterior descending artery and right coronary artery. The spasm was relieved after intracoronary nitroglycerin administration, and intra-aortic balloon pump support was initiated for hemodynamic stabilization. The patient recovered uneventfully and was discharged in good condition. Coronary artery spasm should be considered in cases of unexplained hemodynamic collapse after cardiac surgery. Intraoperative transesophageal echocardiography and hybrid operating room platforms enable rapid diagnosis and integrated treatment, which may improve patient outcomes

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