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[Iatrogenic left coronaro-atrial fistula after mitral valve replacement: apropos of a case]
S A Ramsheyi1, P Nataf, F Jault
1Service de chirurgie thoracique cardiovasculaire, Paris.
Insights
A rare iatrogenic fistula formed between the left circumflex coronary artery and left atrium following mitral valve surgery. This complication was diagnosed using advanced imaging and successfully treated with surgical intervention.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Mitral valve annuloplasty is a common cardiac surgical procedure.
- Reoperations for prosthetic valve complications carry inherent risks.
- Iatrogenic coronary artery fistulas are infrequent but serious complications.
Observation:
- A patient developed a fistula between the left circumflex coronary artery and the left atrium post-reoperation for mitral valvuloplasty.
- The complication arose after implantation of a mechanical hemi-disc prosthesis (Saint Jude Medical).
Findings:
- Transesophageal echocardiography (TEE) and coronary angiography were instrumental in diagnosing the fistula.
- The diagnostic accuracy of TEE and coronary angiography in identifying coronary artery fistulas is high.
Implications:
- Early and accurate diagnosis of iatrogenic coronary artery fistulas is crucial for patient outcomes.
- Surgical management, such as external ligature under cardiopulmonary bypass, can effectively treat these fistulas.
- This case highlights the importance of vigilance for rare complications during cardiac reoperations.
Abstract:
The authors report a case of an iatrogenic fistula between the left circumflex coronary artery and left atrium. The fistula was a complication of reoperation to replace a mitral valvuloplasty annulus by a mechanical hemi-disc prosthesis (Saint Jude Medical). Diagnosis was made by transoesophageal echocardiography and confirmed by coronary angiography. The patient underwent external ligature under cardio-pulmonary bypass.