Management of anomalous left circumflex artery encircling the aortic annulus in a patient undergoing multivalvular surgery

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Cardiac Anatomy

Background:

• Anomalous origin of the left circumflex artery (ALCA) from the right sinus of Valsalva (RSV) with a retroaortic course is a rare coronary anomaly.
• While often asymptomatic, ALCA requires careful consideration in patients undergoing cardiac surgery, particularly aortic valve replacement.
• The complexity increases significantly in multi-valve procedures.

Observation:

• The patient presented with active bacterial endocarditis requiring simultaneous aortic and tricuspid valve surgery.
• Preoperative imaging revealed an anomalous left circumflex artery originating from the proximal right sinus of Valsalva with a retroaortic course.
• This anatomical variation placed the anomalous left circumflex artery at high risk during the planned valve replacement surgeries.

Findings:

• A successful surgical strategy was developed and executed to manage the complex coronary anomaly during double valve surgery.
• The operative approach ensured the protection of the anomalous left circumflex artery throughout the procedure.
• The patient underwent successful aortic and tricuspid valve replacement with no intraoperative complications related to the coronary anomaly.

Implications:

• This case underscores the importance of meticulous preoperative anatomical assessment in patients with coronary anomalies undergoing complex cardiac surgery.
• Demonstrates the feasibility of safely managing high-risk coronary variations during multi-valve operations.
• Highlights the need for tailored surgical planning to mitigate risks associated with anomalous coronary arteries in valve surgery.