PMC4460353_01
Pre-operative right coronary artery
angiography
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Coronary angiography was normal (Figure 1).
Early post-operative electrocardiogram
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The electrocardiogram showed normal sinus rhythm and no any ischemic changes (Figure 2).
Electrocardiogram at the time of chest pain 3 days after the surgery
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New onset ST segment elevation occurred in inferior leads, and ST-T dynamic changes were also occurred in pericardial leads (Figure 3) with hemodynamic instability but no ventricular arrhythmia.
Non-selective aortic root injection
angiography
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Non-selective aortic root injection and selective RCA angiography showed a pronounced spasm of the ostium portion of RCA with aortic gradient in coarctation site: 15-20 mmHg (Figure 4).
Selective right coronary artery angiography after infusion of intravenous trinitroglycerine
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Coronary artery was relieved of vasospasm (Figure 5) and intravenous TNG was maintained for 24 h.
Electrocardiogram after transient right coronary artery spasm
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The ST-T change returned to normal (Figure 6), there was no evidence of myocardial infarction or even dysfunction (LVEF: 55%, mean pressure gradient: 17 mmHg and peak pressure gradient: 31 mmHg).