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

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