Intraoperative Cardiac Arrest: A Rare Case of Anomalous Coronary Arteries in a Previously Apparently Healthy Young Man

Dalhat Salahu1, Misbahu Ahmad2, Atiku Mamuda1

1Department of Anaesthesia, Aminu Kano Teaching Hospital Kano, Nigeria

2Department of Surgery, Aminu Kano Teaching Hospital Kano, Nigeria

Correspondence to: Dr Atiku Mamuda; email: dratiku1963@yahoo.com

Received: 09 Apr 2021; Revised: 01 March 2022; Accepted: 06 Mar 2022; Available online: 11 April 2022

Abstract

Sudden cardiac arrest in an apparently healthy patient is an uncommon and distressing experience for clinicians, and a prompt response improves outcome. A previously undiagnosed underlying cardiac anomaly places patients at risk of intraoperative critical incidents that could be fatal. We herein report a rare case of anomalous coronary arteries in a previously asymptomatic 25-year-old male who was rescheduled for a non-cardiac surgery after two previous episodes of intraoperative cardiac arrests.

Key words: Cardiac arrest, Coronary artery anomaly, Anesthesia, Right coronary artery, Left coronary artery

Ann Afr Surg. 2022; 19(4): 216-220

DOIhttp://dx.doi.org/10.4314/aas.v19i4.10

Conflicts of Interest: None

Funding: None

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction

Intraoperative cardiac arrest during elective, non-cardiac surgery is a rare but potentially catastrophic event. The incidence of intraoperative cardiac arrest varies in different hospitals and countries, and studies have shown an incidence rate ranging from 1.1 to 34.6 per 10,000 anesthesia and a survival rate of 35% to 46.6% (1,2).

The risk factors associated with cardiac arrest in patients undergoing non-cardiac surgery include unstable coronary artery disease, cardiac arrhythmias, heart failure, valvular heart disease. pulmonary embolism, electrolyte abnormalities, hemorrhage, and the anesthetic used at the time of arrest (1,2).

Although congenital coronary artery anomalies are relatively uncommon, they are the second most common cause of sudden cardiac arrest among the young (3). Approximately 1% of the general population have been reported to have an anomalous coronary artery, ranging from 0.3% to 5.6% in studies on patients undergoing coronary angiography (3). These are often not diagnosed until late adolescence or adulthood because of the lack of symptoms, and some teens or adults with unknown anomalies may have an initial episode of chest pain, heart failure, or even sudden cardiac death before the condition is recognized (3).

We herein report a rare case of a patient who experienced recurrent intraoperative cardiac arrest that was associated with a previously undiagnosed anomaly in the coronary arteries.

Case presentation

The patient is a 25-year-old man weighing 89kg who presented to our facility with an 8-week history of paraplegia following a road traffic accident. There was no loss of consciousness or other major systemic injuries. Neurological examination revealed flaccid paralysis of both lower limbs, with a power of 0/5 and hyporeflexia; sensations were intact. Magnetic resonance imaging was requested, which revealed a traumatic burst fracture of T12 with retropulsion and compression of the conus medullaris. He was scheduled for a laminectomy and pedicle screw fixation under general anesthesia.

Pre-anesthesia review revealed a young man with no known comorbid conditions, history of prior exposure to anesthesia, or drug allergy. General examination revealed no abnormalities; chest and cardiovascular examinations were normal, with a good volume pulse of 74 bpm and blood pressure of 110/80mmHg; heart sounds were S1 and S2 only. He had good mouth opening with a Mallampati score of 2. Investigations available were urea electrolyte and creatine, full blood count and differential, fasting blood sugar, and clotting profile, and all were within normal limit ranges. Fasting guidelines were given, and a request was made for two pints of blood.

In the operating suite, a cockpit drill was done to check for oxygen supply, anesthesia equipment, and resuscitative gadgets; baseline vital signs taken with a multiparameter monitor were pulse rate, non-invasi