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Left circumflex coronary artery occlusion after mitral valve annuloplasty: "a stitch in time"

Nir N Somekh1, Ali Haider, Amgad N Makaryus

  • 1Department of Cardiology, North Shore-Long Island Jewish Health System, Manhasset, New York 11030, USA. nir_somekh@yahoo.com

Texas Heart Institute Journal
|March 14, 2012
PubMed

Insights

Mitral valve surgery can injure the left circumflex coronary artery, leading to myocardial infarction. A rare complication of coronary artery stenting, a fistula between the artery and left atrium, was successfully treated.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Anatomy

Background:

  • The left circumflex coronary artery (LCx) is anatomically close to the mitral valve annulus, posing a risk during mitral valve surgery.
  • Surgical manipulation or injury to the LCx can lead to perioperative myocardial infarction (MI).

Observation:

  • A 73-year-old woman developed perioperative MI post-mitral valve repair due to LCx occlusion.
  • Following percutaneous coronary intervention (PCI) for LCx occlusion, a coronary-cameral fistula developed between the stented LCx and the left atrium.
  • This represents the first reported case of a coronary-cameral fistula forming after PCI in the context of mitral valve surgery complications.

Findings:

  • The coronary-cameral fistula was identified as a novel complication post-PCI for iatrogenic LCx injury.
  • The patient underwent successful mitral valve replacement, and the fistula management was implicitly successful given the outcome.

Implications:

  • Increased surgeon awareness of LCx injury during mitral valve surgery is crucial for prevention.
  • Preoperative detailed anatomical assessment and meticulous surgical technique are recommended.
  • Intraoperative transesophageal echocardiography can aid in detecting potential complications like wall-motion abnormalities before surgical closure.

Keywords:
Coronary artery fistulacoronary occlusionheart valve prosthesis implantation/adverse effectsmitral valve annuloplastysurgical complication

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