Injury to the circumflex coronary artery following mitral valve repair

Abstract

In a recent issue of the journal, Zegdi et al. [1] courageously reported a complication that occurred after a mitral valve repair case in which the circumflex coronary artery was acutely occluded due to the prosthetic ring implantation. We too encountered the same complication in three cases: two patients following an extensive annulus decalcification and another following a simple posterior leaflet quadrangular resection. In all patients, the diagnosis of acute myocardial ischemia was suspected in the operating room when facing a variable degree of hemodynamic instability with localized EKG abnormalities; intraoperative echography revealed a segmental lateralwall dysfunction. Revascularization with a saphenous vein graft anastomosed to the obtuse margin immediately improved the situation and all three patients had a normal postoperative outcome. As in Zegdi et al.’s case, all patients had a large and dominant left coronary artery. The circumflex coronary artery is in intimate relation with the mitral annulus, particularly in its anterolateral commissure, P1 and to a lesser degree P2 portions; it is noteworthy that injury to this vessel can occur even in teams with a significant experience in mitral valve repair surgery.