Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiothoracic Surgery Pub Date : 2025-03-26 DOI:10.1186/s13019-025-03387-w

Yimei Lin, Jingyi Wu, Junmei Wu, Juanlan Liu, Chao Liang

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引用次数: 0

Abstract

Background: Coronary artery spasm (CAS) has been frequently documented during regional or general anesthesia. However, severe cardiac arrest induced by CAS as a result of anal-cardiac and vasovagal reflexes is relatively uncommon.

Case presentation: This report describes a patient with a history of CAS and percutaneous coronary angioplasty (PTCA) who experienced coronary artery spasm and subsequent cardiac arrest during anal anastomosis in a transabdominal perineal radical resection of rectal cancer (MILES procedure).

Conclusion: This case study offers significant insights into the pathophysiology of cardiac arrest induced by surgical intervention in the anal region, which is densely innervated by the vagus nerve at the terminal portion of the rectum. This phenomenon may be associated with the anal cardiac reflex and vagus nerve reflexes. It is imperative to recognize the potential for catastrophic outcomes due to vagus nerve excitation during rectal end surgery, particularly in patients with a history of acute CAS.

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来源期刊

Journal of Cardiothoracic Surgery 医学-心血管系统

CiteScore

2.50

自引率

6.20%

发文量

286

审稿时长

4-8 weeks

期刊介绍： Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.