A case of percutaneous coronary intervention for treatment of iatrogenic chronic total occlusion of the left circumflex artery after mitral valve repair

Sunagawa, Osahiko; Hokama, Ryo; Miyara, Takafumi; Taba, Yoji; Toriumi, Takashi

doi:10.1007/s12928-016-0379-z

Cited by 6 publications

(11 citation statements)

References 4 publications

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“…adopted the use of parallel wires technique 24 and Gaba et al the antegrade wire escalation with the support of a microcatheter to cross the lesion. 38 Of note, in our experience, the microcatheter played a significant role in providing support for the guide wire and facilitating lesion crossing as we detailed in Case 3.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature

Benedetti

Castaldi

Poletti

et al. 2023

Cathet Cardio Intervent

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Left circumflex coronary artery (LCx) injury related to mitral valve surgery is a rare complication. The best treatment option is not defined, and percutaneous coronary intervention (PCI) may represent an effective treatment to avoid prolonged myocardial ischemia. To evaluate feasibility and efficacy of PCI treatment, all records of LCx injury related to mitral valve surgery and treated with PCI were included after a systematic PubMed searching. Moreover, we retrospectively analyzed our single‐center PCI database and patients fulfilling the inclusion criteria were included. Patients undergoing transcatheter mitral valve intervention, non‐mitral valve surgery, conservatively or surgically treated after LCx injury were excluded. Data about patient characteristics, procedural details, PCI success, and in‐hospital mortality were collected. Fifty‐six patients were included, 58.9% were male (n = 33) and the median age was 60.5 years (IQR = 21.75). The majority had left dominant or codominant coronary system (62.2%, n = 28 and 15.6%, n = 7, respectively). Clinical manifestations ranged from hemodynamic stability (21.1%, n = 8) to hemodynamic instability (42.1%, n = 16) and cardiac arrest (18.4%, n = 7). On ECG, 23.5% of patients (n = 12) presented ST‐segment depression, 58.8% (n = 30) ST‐segment elevation, 7.8% (n = 4) atrioventricular block, and 29.4% (n = 15) ventricular arrhythmias. Left ventricle dysfunction was present in 52.3% (n = 22) of patients and wall motion abnormalities in 71.4% (n = 30). PCI success rate was 82.1% (n = 46) and in‐hospital mortality 4.5% (n = 2). LCx injury related to mitral surgery is a rare complication characterized by an increased risk of mortality. PCI seems a feasible treatment option, still burdened by suboptimal results, probably related to the technical challenges posed by the surgical failure.

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Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature

Benedetti

Castaldi

Poletti

et al. 2023

Cathet Cardio Intervent

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“…Not always the consequences are immediately evident, but the complication can be diagnosed even after days, 18 months, 19,20 or years. 21,22 In a review of the literature, where cases of MV replacement were included, 7% of the patients had a diagnosis after 30 days from surgery.…”

Section: Lesionmentioning

confidence: 99%

“…It consists in direct revascularization of the occluded vessel or in partial/total removal and reimplantation of the ring, in the area of the anterolateral commissure and P1, passing the stitches as close as possible to the leaflet. Not always the consequences are immediately evident, but the complication can be diagnosed even after days, 18 months, 19,20 or years 21,22 . In a review of the literature, where cases of MV replacement were included, 7% of the patients had a diagnosis after 30 days from surgery.…”

Section: Lesionmentioning

confidence: 99%

Acute iatrogenic complications after mitral valve repair

Paparella

Squiccimarro

Mauro

et al. 2022

Journal of Cardiac Surgery

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Background and Aim of the Study Mitral valve repair is the procedure of choice to correct mitral regurgitation. However, some dangerous iatrogenic complications can occur at the end of the procedure. Therefore, we sought to review the most frequent and clinically relevant acute iatrogenic complication following mitral valve repair. Methods A thorough review of the literature has been performed. Criteria for considering studies for this non‐systematic review were as follows: observational and interventional studies investigating the acute iatrogenic complications following mitral valve repair, and essential review studies pertinent to the topic. Results The most frequent is the systolic anterior motion. Due to a systolic dislocation of the anterior leaflet toward the outflow tract, it causes both obstruction of the outflow tract and mitral regurgitation. Often it is due to excess of catecholamines or to reduced filling of the left ventricle but sometimes needs further surgical maneuvers, focused on moving posteriorly the coaptation line. It can be obtained by shortening the posterior leaflet or increasing the size of the ring or applying an Alfieri stitch to limit the movements of the anterior leaflet. Another complication, often underdiagnosed and potentially lethal, is the injury of the circumflex artery that happens at the level of the anterolateral commissure or P1 zone. Two mechanisms are involved. The first one is the direct injury of the artery by a stitch (roughly 25% of the patients present a distance artery‐annulus <3 mm. The second one is the distortion of the artery, attracted toward the annulus by a misplaced stitch. The attraction causes kinking with stenosis of different degrees till functional occlusion. However, the artery has to be far from the annulus and the atrial tissue has to be stiff and resistant, as after an infective process, to move the circumflex artery toward the annulus without tearing. Positioning the stitches very close to the mitral leaflets in the dangerous area is the only prevention to the complication. The treatment in the operating theater is partial or total removal/reimplantation of the annular sutures or coronary artery bypass grafting to the circumflex area. If the injury is demonstrated only after coronary angiography, percutaneous revascularization can be attempted before further surgical treatment. Conclusions Acute iatrogenic complication after mitral repair exists and may compromize patient outcome. Raising awareness about these issues, the precautions to prevent them, and the manners of resolution is therefore mandatory.

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“…It consists in direct revascularization of the occluded vessel or in partial/total removal and re-implantation of the ring, in the area of the anterolateral commissure and P1, passing the stitches as close as possible to the leaflet. Not always the consequences are immediately evident, but the complication can be diagnosed even after days [17], months [18][19] or years [20][21]. In a review of the literature, where cases of MV replacement were included, 7% of the patients had a diagnosis after 30 days from surgery.…”

Section: Circumflex Artery Lesionmentioning

confidence: 99%

Acute Iatrogenic Complications After Mitral Valve Repair

Paparella

Squiccimarro

Mauro

et al. 2022

Preprint

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Mitral valve repair is the procedure of choice to correct mitral regurgitation. However, some dangerous complications, correlated to the surgical technique, can occur in the operating theatre, at the end of the procedure. The most frequent is the systolic anterior motion. Due to a systolic dislocation of the anterior leaflet toward the outflow tract, it causes both obstruction of the outflow tract and mitral regurgitation. Often it is due to excess of catecholamines or to reduced filling of the left ventricle, but sometimes needs further surgical maneuvers, focused on moving posteriorly the coaptation line. It can be obtained by shortening the posterior leaflet or increasing the size of the ring or applying an Alfieri stitch to limit the movements of the anterior leaflet. Another complication, often underdiagnosed and potentially lethal, is the injury of the circumflex artery that happens at the level of the anterolateral commissure or P1 zone. Two mechanisms are involved. The first one is direct injury of the artery by a stitch (roughly 25% of the patients present a distance artery-annulus<3 mm). The second one the distortion of the artery, attracted toward the annulus by a misplaced stitch. The attraction causes kinking with stenosis of different degrees till functional occlusion. However, the artery has to be far from the annulus and the atrial tissue has to be stiff and resistant, as after an infective process, to move the CX toward the annulus without tearing. Positioning the stitches very close to the mitral leaflets in the dangerous area is the only prevention to the complication. The treatment in the operating theatre is partial or total removal/re-implantation of the annular sutures or coronary artery bypass grafting to the circumflex area. If the injury is demonstrated only after a coronary angiography, percutaneous revascularization can be attempted before further surgical treatment.

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A case of percutaneous coronary intervention for treatment of iatrogenic chronic total occlusion of the left circumflex artery after mitral valve repair

Cited by 6 publications

References 4 publications

Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature

Percutaneous treatment of left circumflex coronary artery injury related to mitral valve surgery: Case series and systematic review of the literature

Acute iatrogenic complications after mitral valve repair

Acute Iatrogenic Complications After Mitral Valve Repair

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