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Compression of an anomalous left circumflex coronary artery by a bioprosthetic valve ring
E J de Marchena1, C D Russo, P M Wozniak
1Cardiology Section, Veterans Administration Medical Center, Miami, Florida.
Insights
The rare origin of the left circumflex artery from the right coronary artery can cause clinical issues after aortic valve replacement. Angiography revealed compression of this coronary artery by the bioprosthetic aortic valve ring.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery anomalies are relatively common, with the most frequent being the origin of the left circumflex artery from the right sinus of Valsalva.
- This anatomical variation is typically asymptomatic and rarely leads to clinical complications.
Observation:
- A patient with this coronary anomaly experienced significant clinical events following a bioprosthetic aortic valve replacement.
- The circumflex artery became entrapped and compressed between the Hancock aortic valvular ring and the mitral valve apparatus.
Findings:
- This case represents the first antemortem angiographic demonstration of circumflex artery compression by an aortic bioprosthetic ring.
- The compression was solely attributed to the aortic bioprosthetic ring, without other contributing factors.
Implications:
- Patients with coronary artery anomalies require special surgical considerations during aortic valve replacement procedures.
- This finding highlights the potential for iatrogenic coronary artery compression following cardiac surgery.
Abstract:
The most common anomaly of the coronary arteries is the origin of the left circumflex artery from the right sinus of Valsalva or the right coronary artery proper. This anomaly is rarely clinically significant. A patient is reported here who has such an anomaly which did become clinically significant after a bioprosthetic aortic valve replacement. The circumflex artery described here became compressed between the Hancock aortic valvular ring and the mitral valvular apparatus. This case is the first antemortem report of such a compression to be demonstrated angiographically and the first case to be the results of an aortic bioprosthetic ring alone. Special surgical considerations must be made when performing valvular replacements on patients with this coronary artery anomaly.