The hazards to the left circumflex coronary artery during mitral valve surgery in cases with atrial septal defects and corrected transposition.

Abstract

In spite of the knowledge gained from earlier reports about injury to the circumflex coronary artery, we have encountered such lethal damage in a case of corrected transposition with mitral insufficiency and an atrial septal defect. Due to the abnormal anatomy of the heart, the circumflex artery was injured 10 cm from its origin by one of the sutures for the annuloplasty performed through the atrial septal defect. In all other described cases, the artery has been injured 2.5 to 3 cm from its origin. The delayed onset of symptoms may be due to the comparatively distal injury to the circumflex coronary artery in the case of corrected transposition resulting in smaller infarction. In the second case, with mitral valve replacement at re-operation for mitral insufficiency in a case of primum defect of the atrial septum with cleft mitral valve, the injury to the circumflex coronary artery by one stitch was detected. The stitch was replaced more superficially and the patient made an uneventful recovery.