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Review
. 2023 Oct 27:10:1183182.
doi: 10.3389/fcvm.2023.1183182. eCollection 2023.

When too much closeness harms: circumflex artery injury during mitral valve surgery

Christian Dumps  1 , Philipp Simon  1 , Evaldas Girdauskas  2 , Felix Girrbach  1
Affiliations
Review

When too much closeness harms: circumflex artery injury during mitral valve surgery

Christian Dumps et al. Front Cardiovasc Med. .

Abstract

Occlusion of the left coronary circumflex artery (LCX) during surgical procedures of the mitral valve is an infrequent but potentially life-threatening complication (1-3). Due to its close anatomical relationship to the posterior mitral valve annulus, there is a relevant risk of causing a stenosis or an occlusion of the left circumflex artery, especially by surgical annular sutures. The perioperative clinical course is heterogeneous, ranging from-initially-asymptomatic or solely electrocardiographic abnormalities to cardiogenic shock. Both severely impaired ventricular contractility or malignant arrhythmia may potentially lead to a weaning failure from cardiopulmonary bypass (CPB) and eventually result in chronic heart failure with persistently reduced ejection fraction. Possible therapeutic strategies include the immediate reopening of causal sutures, aortocoronary bypass grafting or percutaneous coronary intervention (PCI), yet PCI seems to be the preferred method at present.

Keywords: cardiac surgery; coronary occlusion; heart valve prosthesis implantation; minimally invasive surgery; mitral valve; mitral valve insufficiency; valvular annuloplasty.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) LCX in long axis without flow in the midsegment through suture occlusion (TOE view: modified mid-esophageal aortic valve long axis view according to ender et al. (35) (ME AV LAX) with color flow Doppler, Nyquist limit <30 cm/s). (B) As a contrast: inconspicuous longitudinal view of a prominent LCX (TOE View: modified Mid-esophageal long axis view (mod. ME LAX) with color flow Doppler, Nyquist limit <30 cm/s. (C) Prominent LCX in long axis without flow detection in the proximal third and without the possibility of echocardiography imaging the LCX in the full length due to an estimated occlusion to be expected further peripherally [TOE view: modified mid-esophageal two chamber view (ME 2CH) with color flow Doppler, Nyquist limit <30 cm/s].
Figure 2
Figure 2
(A) coronary angiogram LAO 30°/caudal 20° with LCX occlusion (arrow) in the proximal to mid segment; also visible: mitral valve annuloplasty ring (*); ST elevation in ECG (**). (B) Flow in LCX after successful stent PCI.
See this image and copyright information in PMC

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