Aortic valve/root procedures in patients with an anomalous left circumflex coronary artery and a bicuspid aortic valve: anatomical and technical implications

Abstract

An anomalous origin of the left circumflex coronary artery that arises as a side branch of the right coronary artery from the right coronary sinus of Valsalva encircling the aortic annulus is usually an incidental finding. However, in patients undergoing aortic valve procedures, its existence can significantly complicate the surgical treatment. We report our operative strategy in patients with an anomalous left circumflex coronary artery, a bicuspid aortic valve morphology and different aortic valve pathologies.

Incidental finding of anomalous circumflex coronary artery from right coronary sinus prior to aortic valve surgery

“…Congruent with the case presented, anomalous Cx artery is reported to be more likely in patients with bicuspid aortic valve 4. This anomaly is classified as benign since it is not associated with sudden cardiac arrest 5.…”

“…The impact of an anomalous origin of Cx artery on procedures involving the coronary arteries, aortic root or aortic valve is evident 4. Failure to recognise such coronary anomaly may lead to life-threatening events.…”

“…Coronary vessels might also be compressed by the prosthetic valve ring, leading to myocardial ischaemia in the relevant territory 4 9. Depending on the exact origin of the anomalous Cx artery, a sutureless valve could potentially give a safer approach as suggested by Giuseppe Cerillo et al 10…”

Unusual Prebypass Echocardiographic Findings Before Bicuspid Aortic Valve Surgery

“…Nevertheless, the context may be crucial because an anomalous connection of the CX coronary artery with an almost exclusive retroaortic course (see Fig 4) commonly is considered low risk, except before cardiac valve surgery. 3,4 Imaging Techniques…”

“…From a surgical point of view, these findings are of crucial importance to avoid injury of the aberrant coronary artery, either directly by the needles or indirectly by compression from a large prosthetic valve, with a risk of subsequent perioperative myocardial infarction. 3,4 It is particularly important to have this information before determining the surgical approach. Indeed, the benefits of smaller incisions (ministernotomy or minithoracotomy) are counterbalanced by the effects of reducing the visibility and surgical access in complex surgical procedures.…”