[A case of refractory spasm of multiple coronary arteries and left internal thoracic artery graft following off-pump CABG].

: A 61-year-old man with exertional angina was underwent off-pump CABG with left internal thoracic artery being constructed to his left anterior descending artery. Two hours after surgery, complete atrioventricular block developed with circulatory collapse. Emergency cardiac catheterization showed multiple coronary artery spasms and LITA graft spasm, which were refractory to intracoronary and intragraft nitroglycerin injection. So we established IABP and continuous hemofiltration (CHF) urgently. Thereafter, his hemodynamics gradually improved and spasm did not recur. His postoperative angiogram revealed no significant narrowing in coronary arteries and patent anastomosis. IABP and CHF might be one of useful procedure for refractory postoperative coronary spasm.