Abstract
Injury of the left circumflex coronary artery is a potentially serious complication of mitral valve surgery due to the proximity of the vessel to the posterior segment of the mitral annulus. Suture-related distortion of the artery with partial or subtotal occlusion is the most commonly implicated mechanism. Herein, we present a case of symptomatic iatrogenic circumflex coronary artery stenosis following mitral valve annuloplasty for degenerative mitral valve regurgitation.
Highlights
An iatrogenic coronary artery injury following cardiac valve surgery is a rare but underrecognized entity
An unintentional capture of the artery with the suture material during surgery can lead to an iatrogenic coronary stenosis
We present a case of an undiagnosed iatrogenic left circumflex coronary artery following mitral valve repair that manifested with recurrent effort angina
Summary
An iatrogenic coronary artery injury following cardiac valve surgery is a rare but underrecognized entity. The patient has a history of atrial fibrillation and severe degenerative mitral regurgitation but no history of coronary artery disease Two years prior, he underwent mitral valve repair with a quadrangular resection of the posterior leaflet and ring annuloplasty with a 34-mm Memo 3D annuloplasty ring (Sorin Group, Italy), a modified maze procedure, and an exclusion of the left atrial appendage with AtriCure (AtriCure, Mason, OH). Due to his recurrent chest pain, a repeat angiogram was done, which showed severe stenosis and distortion of the mid circumflex artery in close proximity to the suture line of the mitral ring (Figure 2A). The patient’s chest pain has resolved and he remained free from chest pain at the four weeks follow-up
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