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Compression of anomalous circumflex coronary artery by a prosthetic valve ring
J P Veinot1, V C Acharya, P Bedard
1Department of Laboratory Medicine, Ottawa Civic Hospital, Heart Institute, University of Ottawa, Ontario, Canada.
Insights
An anomalous origin of the circumflex coronary artery, usually benign, can cause severe complications. Aortic valve replacement surgery led to prosthesis distortion, causing myocardial infarction and sudden death in a patient with this coronary anomaly.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anatomy
- Pathophysiology
Background:
- Anomalous origin of the circumflex coronary artery from the right aortic sinus with a retroaortic course is a rare congenital coronary anomaly.
- This anatomical variation is typically asymptomatic and discovered incidentally.
Observation:
- A patient with bicuspid aortic valve underwent aortic valve replacement.
- Post-operatively, the sewing ring of the prosthetic valve was noted to distort the retroaortic circumflex coronary artery.
Findings:
- The distortion of the circumflex coronary artery led to myocardial infarcts.
- The patient experienced sudden cardiac death during physical exertion.
Implications:
- This case highlights a potential iatrogenic complication of aortic valve surgery in patients with anomalous coronary arteries.
- Careful pre-operative imaging and surgical planning are crucial to avoid compromising coronary artery flow.
- This emphasizes the importance of understanding coronary anatomy in cardiac interventions.
Abstract:
Anomalous origin of the circumflex coronary artery from the right aortic sinus, with a retroaortic course, is usually without consequence. We report a patient who underwent aortic valve replacement for bicuspid aortic valve. The prosthesis sewing ring distorted the circumflex, producing myocardial infarcts and sudden death during exercise.