Prevention of coronary spasms during aorto-coronary (A-C) bypass surgery for variant angina and effort angina with ST-elevation.

Aorto-coronary (A-C) bypass surgery was carried out in 15 cases of Prinzmetal's angina and effort angina with ST-elevation, commonly ascribed to coronary vasospasms. A-C bypass surgery is usually indicated for vasospastic angina when there are significant organic lesions of the coronary arteries. Fifty mg of verapamil was added to the priming solution for cardiopulmonary bypass, and A-C bypass surgery was successfully performed without the occurrence of perioperative coronary spasms even though severe episodes of spasm had been documented before surgery. However, four cases of vasospastic angina not receiving verapamil developed coronary spasms during or after A-C bypass surgery. It was concluded that administration of verapamil, a potent calcium entry blocking agent, is effective in preventing perioperative coronary vasospasms. Patency of the saphenous vein grafts bypassing the spasm-related coronary arteries was satisfactory.