Abstract
Ishemic heart disease including myocardial infarction is one of the most serious perioperative complications. We experienced two cases of ischemic heart disease due to abrupt arrhythmia after spinal surgery. One case showed ventricular fibrillation soon after surgery and the other showed atrial premature contraction two days after surgery on electrocardiogram. Although they did not present any abnormal findings on routine preoperative examinations (chest x-ray radiograph, electrocardiogram, and echocardiogram), constriction of the coronary artery was indicated by postoperative angiography. They were treated by coronary artery bypass graft and completely recovered without after-effects.
Patients with spinal disorders seldom display symptoms of myocardial ischemia because of reduced daily activities in terms of motor dysfunction. On the other hand, positional changes under unstable cardiovascular dynamics during surgery may have possibility to induce the ischemic responses of heart muscles. In other words, it is extremely difficult to make the accurate diagnosis of myocardial ischemia preoperatively and is critical once it occurrs.
We should bear in mind that asymptomatic myocardial ischemic patients who do not show any abnormal findings in usual preoperative screening do exist when attempting spinal surgery.
