Unexpected entrapment during surgery of anomalous circumflex coronary artery arising from right coronary artery
María Elena Arnáiz García1, Jose María González-Santos1, María Elena Pérez-Losada2
1Department of Cardiovascular Surgery, University Hospital of Salamanca, Spain.
Insights
A rare case of anomalous left circumflex coronary artery (LCCA) entrapment occurred after heart valve surgery. This complication, caused by a surgical suture, led to myocardial ischemia but was successfully managed.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anatomy
- Interventional Cardiology
Background:
- Rheumatic heart valve disease necessitates complex surgical interventions, including valve replacement and annuloplasty.
- Anatomical variations, such as anomalous coronary artery origins, can present unique surgical challenges.
- The left circumflex coronary artery (LCCA) typically arises from the left coronary sinus; anomalous origins require careful surgical consideration.
Abstract:
A patient with advanced rheumatic heart valve disease underwent aortic and mitral valve replacement with tricuspid ring annuloplasty. There was an anomalous left circumflex coronary artery (LCCA) arising from the right coronary artery (RCA) running along the anterior surface of an enlarged right ventricle (RV). During the immediate postoperative course, signs of inferior and lateral myocardial ischemia developed. An emergent coronary angiography revealed LCCA entrapment. An additional suture placed in the RV outflow tract used to optimize exposition of the aortic root during the aortotomy was determined to be the origin of the coronary entrapment. No similar case of LCCA occlusion has previously been reported. This is a description of successful management of this complication.
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