Anomalous circumflex artery encircling the aortic annulus: implications for mitral valve repair

J Cardiothorac Surg. 2024 May 7;19(1):281. doi: 10.1186/s13019-024-02779-8.

Abstract

Injury to coronary arteries during mitral surgery is a rare but life-threatening procedural complication, an anomalous origin and course of the left circumflex artery (LCx) increase this risk. Recognizing the anomaly by the characteristic angiographic pattern and identifying its relationship with the surrounding anatomical structure using imaging techniques, mainly transesophageal echocardiography (TOE) or coronary computed tomography angiography (CCTA), is of crucial importance in setting up the best surgical strategy. We report a case of anomalous origin of a circumflex artery (LCx) from the proximal portion of the right coronary artery (RCA) with a pathway running retroaortically through the mitro-aortic space. An integrated diagnostic approach using a multidisciplinary team with a cardiologist and an imaging radiologist allowed us to decide the surgical strategy. We successfully performed a mitral valvular repair using a minimally invasive minithoracotomic approach and implanting a complete semirigid ring.

Keywords: Anomalous circumflex coronary course; Coronary injury; Intraoperative complication; Mitral valve surgery.

Publication types

  • Case Reports

MeSH terms

  • Aortic Valve* / abnormalities
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / surgery
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Vessel Anomalies* / diagnostic imaging
  • Coronary Vessel Anomalies* / surgery
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / surgery
  • Echocardiography, Transesophageal*
  • Female
  • Humans
  • Male
  • Mitral Valve Insufficiency / diagnostic imaging
  • Mitral Valve Insufficiency / surgery
  • Mitral Valve* / abnormalities
  • Mitral Valve* / diagnostic imaging
  • Mitral Valve* / surgery