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Case Reports
. 2019 Dec 18;1(4):503-507.
doi: 10.1016/j.jaccas.2019.08.030. eCollection 2019 Dec.

Mitral Valve Repair and Anomalous Origin of Circumflex Artery: To Ring or Not to Ring

Assunta Fabozzo  1 , Elena Rossi  1 , Gabriele Facci  1 , Tomaso Bottio  1 , Gino Gerosa  1
Affiliations
Case Reports

Mitral Valve Repair and Anomalous Origin of Circumflex Artery: To Ring or Not to Ring

Assunta Fabozzo et al. JACC Case Rep. .

Abstract

We describe a case of an adult patient with mitral valve regurgitation and the anomalous origin and course of the left circumflex coronary artery. Use of a ringless procedure or a microinvasive approach, such as transapical neochordae implantation, would have possibly avoided a life-threatening post-operative complication. (Level of Difficulty: Advanced.).

Keywords: AAOCA, anomalous aortic origin of coronary artery; LCA, left coronary artery; LCX, left circumflex coronary artery; LV, left ventricular; RCS, right coronary sinus; TTE, transthoracic echocardiogram; V-A ECMO, veno-arterial extracorporeal circulatory membrane oxygenator; cardiac risk; computed tomography; coronary vessel anomaly; mitral valve.

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Figures

None
Graphical abstract
Figure 1
Figure 1
3D Preoperative Echocardiogram Preoperative 3-dimensional echocardiography showing prolapse of the P2 scallop of the mitral valve. AV = aortic valve; MR = mitral regurgitation; PV = pulmonary valve; TV = tricuspid valve.
Figure 2
Figure 2
Preoperative Angiogram Preoperative angiography showing the anomaly origin and course of the circumflex artery. LCX = left circumflex coronary artery; RCA = right coronary artery.
Figure 3
Figure 3
Preoperative Cardiac Computed Tomography Scan Preoperative cardiac computed tomography showing the retro-aortic course of the circumflex artery. On the left, 3-dimensional reconstruction of the computed tomography images on the right. LA = left atrium; other abbreviations as in Figure 2.
Central Illustration
Central Illustration
Schematic of the Left Circumflex Coronary Artery Schematic of the left circumflex coronary artery anomalous aortic origin and course during mitral valve repair with a complete prosthetic ring compared to normal course (upper left box). RCS = right coronary sinus.
Figure 4
Figure 4
Postoperative Angiogram Postoperative angiography showing a mitral prosthetic ring in place occluding the mid-portion of the circumflex artery (small black arrow). ECMO = extracorporeal membrane oxygenator; IVC = inferior vena cava; LCX = left circumflex artery; MV = mitral valve.
See this image and copyright information in PMC

References

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